Can extant comorbidity indices identify patients who experience poor outcomes following total joint arthroplasty?

McConaghy, Kara; Orr, Melissa N.; Sinclair, SaTia T.; Klika, Alison K.; Piuzzi, Nicolás S.

doi:10.1007/s00402-021-04250-y

Cited by 12 publications

(8 citation statements)

References 38 publications

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“…In this study, octogenarians showed a higher ASA-Score (2.45), but there was no statistical significance to systemic complications (ASA-Score > 3; p = 0.291). This is in line with McConaghy et al who described that the ASA-Score cannot predict minor and major complications [ 20 ]. Several studies described a relationship between age and cardiac complications [ 21 – 23 ].…”

Section: Discussionsupporting

confidence: 89%

The risk analysis of perioperative complications of cementless hip arthroplasty in octogenarians

Koettnitz

Jäcker

Migliorini

et al. 2022

Arch Orthop Trauma Surg

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Introduction Hip arthroplasty is exposed to demographic change as patients age. Analysis of risk factors for surgical treatment decisions in the group of ≥ 80-year-old patients is crucial. Healthcare systems in developed countries are being tested medically and financially by the ageing population. Therefore, this study analysed the perioperative complications of cementless primary hip arthroplasty in octogenarians and compared them with patients aged ≤ 60 years. Methods A retrospective data analysis of the year 2017 was done in a maximum care hospital of General Orthopaedic Surgery. Patients aged ≥ 80 years or ≤ 60 years with primary cementless hip arthroplasty were included. The outcome of interest was surgery-related and systemic complications, the development of haemoglobin and the incidence of blood transfusion after cementless primary hip arthroplasty in octogenarians during the hospitalisation and the follow-up treatment. Chi-square tests and Fischer's exact test were used for nominal variables. The two-factorial variance analysis-mixed model was used for Hb analyses and the Welch test for group comparison for metric parameters. Results There was a significantly increased incidence of systemic complications during hospitalisation in the ≥ 80-year-old patients (phi 0.26; Std. Ri − 0.8 (A), 2.2 (B); p = 0.007), as well as a significantly increased rate of blood transfusions (phi 0.403; Std. Ri − 1.3 (A), 3.2 (B); p = < 0.001). No clustered pre-existing conditions in the ≥ 80-year-old patients pointed out a significant association with the incidence of systemic complications. Surgery-related complications showed no significant difference during hospitalisation and follow-up treatment. Conclusion The study reveals that primary cementless hip prosthesis implantation is a safe procedure without increased incidence of surgery-related complications. Increased attention should be paid to interdisciplinary preoperative optimisation (adjustment of blood pressure, blood transfusions, if necessary, safe exclusion of urinary tract infections) and postoperative care of octogenarians (tight laboratory examinations, geriatric co-attendance).

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Section: Discussionsupporting

confidence: 89%

The risk analysis of perioperative complications of cementless hip arthroplasty in octogenarians

Koettnitz

Jäcker

Migliorini

et al. 2022

Arch Orthop Trauma Surg

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“…Though functional status has been commonly associated with the definition of frailty, the variables of diabetes, chronic obstructive pulmonary disease (COPD), hypertension, and congestive heart failure (CHF) are more commonly defined as comorbidities. 18,19 To more precisely incorporate the multifactorial nature of frailty, Hall et al 20,21 developed the Risk Analysis Index (RAI) in 2017 in an effort to provide an effective screening tool to assess the frailty of surgical patients. This frailty index including both the prospective clinical RAI and the retrospective administrative RAI (RAI-A) could be easily calculated from variables captured by the Veterans Affairs Surgical Quality Improvement Program and the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) databases includes both comorbidities and functional status variables that robustly measures baseline frailty status, and has recently been validated in a prospective, single-center spine surgery study, 22 and also by us in brain tumor resection patients.…”

Section: Neurospine Eissn 2586-6591 Pissn 2586-6583mentioning

confidence: 99%

“…While the mFI indices have been classically used for frailty assessment, however mFI are more a measure of comorbidity rather than frailty. Though functional status has been commonly associated with the definition of frailty, the variables of diabetes, chronic obstructive pulmonary disease (COPD), hypertension, and congestive heart failure (CHF) are more commonly defined as comorbidities [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Risk Analysis Index and Its Recalibrated Version Predict Postoperative Outcomes Better Than 5-Factor Modified Frailty Index in Traumatic Spinal Injury

et al. 2022

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Objective: To assess the discriminative ability of the Risk Analysis Index-administrative (RAI-A) and its recalibrated version (RAI-Rev), compared to the 5-factor modified frailty index (mFI-5), in predicting postoperative outcomes in patients undergoing surgical intervention for traumatic spine injuries (TSIs).Methods: The Current Procedural Terminology (CPT) and International Classification of Disease-9 (ICD-9) and ICD-10 codes were used to identify patients ≥ 18 years who underwent surgical intervention for TSI from National Surgical Quality Improvement Program (ACS-NSQIP) database 2015–2019 (n = 6,571). Multivariate analysis and receiver operating characteristic (ROC) curve analysis were conducted to evaluate the comparative discriminative ability of RAI-Rev, RAI-A, and mFI-5 for 30-day postoperative outcomes.Results: Multivariate regression analysis showed that with all 3 frailty scores, increasing frailty tiers resulted in worse postoperative outcomes, and patients identified as frail and severely frail using RAI-Rev and RAI-A had the highest odds of poor outcomes. In the ROC curve/C-statistics analysis for prediction of 30-day mortality and morbidity, both RAI-Rev and RAI-A outperformed mFI-5, and for many outcomes, RAI-Rev showed better discriminative performance compared to RAI-A, including mortality (p = 0.0043, DeLong test), extended length of stay (p = 0.0042), readmission (p < 0.0001), reoperation (p = 0.0175), and nonhome discharge (p < 0.0001).Conclusion: Both RAI-Rev and RAI-A performed better than mFI-5, and RAI-Rev was superior to RAI-A in predicting postoperative mortality and morbidity in TSI patients. RAI-based frailty indices can be used in preoperative risk assessment of spinal trauma patients.

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“…Previous studies have shown these factors to independently increase risk for revision surgery and thus theoretically they may also impact mortality rate after revision surgery. 20,[31][32][33] Nevertheless, our study includes 1 of the largest cohorts of rTHA patients described and is 1 of the only studies exclusively characterising inpatient mortality rates in aseptic and septic groups.…”

Section: Discussionmentioning

confidence: 99%

Decreasing trend of inpatient mortality rates of aseptic versus septic revision total hip arthroplasty: an analysis of 681,034 cases

Kobryn

Krebs

et al. 2022

HIP International

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Background: While most revision total hip arthroplasties (rTHAs) are for aseptic loosening/instability, infection accounts for approximately 16%. The purpose of this study was to: (1) quantify mortality rates of aseptic versus septic rTHA; (2) determine if mortality rates have changed over the past 20 years; and (3) identify associated preoperative risk factors, focusing on the utility/validity of the Elixhauser comorbidity index (ECI). Methods: ICD-9/ICD-10 codes were used to identify patients undergoing rTHA in the National Inpatient Sample database between 1998 and 2017. A total of 681,034 cases (576,143 aseptic THA and 104,891 septic THA) were identified. For each patient, demographic variables including age, sex, race, insurance type, ECI, and inhospital mortality were gathered. A logistic regression model was constructed to assess risk of inhospital mortality. Results: From 1998 to 2017, inpatient mortality rates of aseptic and septic rTHA decreased from 0.83 to 0.45%, and from 2.58 to 1.24%, respectively. Septic rTHA was independently associated with higher odds of mortality relative to aseptic (odds ratio (OR): 2.305, 95% confidence interval (CI): (2.014, 2.638), p < 0.0001). Increased ECI was associated with higher odds of mortality at both medium (OR: 5.147, 95% CI: (4.433,5.977), p < 0.0001) and high index scores (OR: 13.714, 95% CI: (11.519,16.326), p < 0.0001). Conclusions: Mortality rates for both aseptic and septic rTHA have been declining over the past 20 years, potentially due to patient selection guidelines and advances in medical management. Our study confirms that the ECI is independently associated with increased inpatient mortality.

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Can extant comorbidity indices identify patients who experience poor outcomes following total joint arthroplasty?

Cited by 12 publications

References 38 publications

The risk analysis of perioperative complications of cementless hip arthroplasty in octogenarians

The risk analysis of perioperative complications of cementless hip arthroplasty in octogenarians

Risk Analysis Index and Its Recalibrated Version Predict Postoperative Outcomes Better Than 5-Factor Modified Frailty Index in Traumatic Spinal Injury

Decreasing trend of inpatient mortality rates of aseptic versus septic revision total hip arthroplasty: an analysis of 681,034 cases

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