Key result
Preoperative frailty marks only ~20% of patients suffering fatal or ICU outcomes post-THA/TKA.
Why the study?
With increasing demand for THA and TKA and more patients presenting with comorbidities that may increase complication risks, the authors aimed to elucidate preoperative characteristics of patients who died or required ICU admission within 90 days.
Does preoperative frailty predict fatal outcome or ICU admission within 90 days after elective THA or TKA?
Observational (n=33,758)
Does preoperative frailty predict fatal outcome or ICU admission within 90 days after elective THA or TKA?
Only 20% of patients with a fatal outcome or ICU admission after elective THA or TKA were categorized as frail based on the modified Frailty Index, suggesting it may not be a sufficient standalone risk stratification tool.
Answers are grounded in this paper and cite their sources.
Frailty may miss most patients at risk for death or ICU after elective THA/TKA; leaves open its utility in preoperative risk stratification.
BACKGROUND: With increasing demand for total hip arthroplasty (THA) and total knee arthroplasty (TKA), a higher percentage of patients are identified with comorbidities that might increase the risk of complications. We aimed to elucidate the preoperative characteristics of patients with a fatal outcome or admission to the Intensive Care Unit (ICU) within 90 days after THA or TKA. We arbitrarily hypothesized that more than 50% of those patients would be frail. METHODS: This is a register based, explorative study including patients undergoing elective, unilateral, primary THA or TKA in the Capital Region of Denmark from 2010 to 2017, and who subsequently died or were admitted to the ICU within 90 days. The modified Frailty Index (mFI) was calculated from the medical records, and a score of ≥0.36 defined frailty. RESULTS: A total of 33,758 patients underwent THA or TKA, and 284 patients (0.8%) died or were admitted to the ICU within 90 days. Fifty-seven patients (20%) were frail (95% CI 16.2-25.7%). The most common comorbidities were hypertension (63%) and pulmonary diseases (32%), and 56% used walking aids. Two or more comorbidities were present in 65% of patients, and 14% had no comorbidities at all. CONCLUSION: Only 20% of patients with a fatal outcome or ICU admission after elective THA or TKA could be categorized as frail based on the mFI. Further studies with a prospective design are needed to clarify the mFI as a risk stratification tool in elderly multimorbid patients undergoing elective arthroplasty surgery.
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Laursen et al. (2021) conducted an observational in Total hip and knee arthroplasty (n=33,758). Preoperative frailty (modified Frailty Index ≥0.36) was evaluated on Proportion of frail patients among those with a fatal outcome or ICU admission (95% CI 16.2-25.7). Preoperative frailty was present in only 20% (95% CI 16.2-25.7%) of patients who died or were admitted to the ICU within 90 days after elective total hip or knee arthroplasty.
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