Frailty Among Total Hip and Knee Arthroplasty Recipients: Epidemiology and Propensity Score-weighted Analysis of Effect on In-hospital Postoperative Outcomes

Abstract

Introduction:Total joint arthroplasty (TJA) is one of the most successful and frequently performed procedures in the United States. The number of these procedures is projected to continue growing rapidly in the coming years, and with it comes the demand for more sophisticated perioperative risk and complication assessment. This study examines the effect of frailty on postoperative inpatient complications and hospital resource utilization after TJA.Methods:Discharge data from the National Inpatient Sample were used to identify all patients aged 50 years or older who underwent TJA between 2006 and 2015. Nonelective admissions and hip fractures were excluded. Patients were stratified into two groups with and without concomitant ICD-9 diagnostic criteria that qualified them has having frailty. An analysis comparing the 2 groups' epidemiology, medical comorbidities, and propensity score-weighted postoperative clinical and economic outcomes was done.Results:A total of 7,854,890 TJAs were included in this analysis, with 136,516 meeting the criteria for frailty and 7,718,374 being nonfrail. Among these patients, the average age was 67.3 years and the female distribution was 61.1%. Frail patients were found to have markedly higher rates of all but two individual comorbidities constituting the Modified Elixhauser Profile compared with nonfrail patients. Compared with the control group, frail patients were found to have increased risk of any postoperative complication, central nervous system complications, hematoma/seroma, wound dehiscence, infection, and postoperative anemia. Frail patients also had longer length of stay, higher discharge to rehabilitation facilities, and higher hospital charges.Discussion:Patients with frailty undergoing TJA procedures are at a markedly higher risk for developing postoperative complications and worse hospital economic outcomes. As this patient population continues to increase, it is imperative for clinicians to use their risk factors in optimizing their perioperative care and support.

Frailty Among Revision Total Knee Arthroplasty Recipients: Epidemiology and Propensity Score-weighted Analysis of Effect on In-hospital Postoperative Outcomes

“…This finding mirrors previous literature that demonstrates an increased risk of women to possess factors that contribute to frailty. 11,[18][19][20] There is evidence in the literature highlighting a higher percentage of women among primary TKA recipients in the general and frail populations, and the findings of this study mirror the trend with similar distribution among rTKA. 12,21 Additional assessment of gender disparities among rTKA recipients and its effect on outcomes as a function of frailty may be useful for preoperative planning and optimization.…”

“…21, 783.22), muscular wasting and disuse atrophy (728.2), senility without mention of psychosis (797), malaise and fatigue (780.79), as validated in previous studies. [6][7][8][9][10][11][12][13] The inverse probability of treatment weighting with complex survey data was used to minimize confounding bias and adjust for comorbidity severity. Propensity score weighting was done per the method of DuGoff et al 7 by weighting patient demographics, hospital characteristics, reason and type of revision, and comorbidities using a modified version of the Elixhauser Comorbidity Index (ECI).…”

“…Frail patients were identified as those with at least one of the following ICD-9 codes: pressure ulcer (707.0X, 707.2X), cachexia (799.4), adult failure to thrive (783.7), muscle weakness (728.87), debility (799.3), difficulty in walking (719.7), history of fall (V15.88), abnormality of gait (781.2), anorexia (783.0), abnormal loss of weight and underweight (783.21, 783.22), muscular wasting and disuse atrophy (728.2), senility without mention of psychosis (797), malaise and fatigue (780.79), as validated in previous studies. 6-13…”

Frailty Among Total Hip and Knee Arthroplasty Recipients: Epidemiology and Propensity Score-Weighted Analysis of Effect on In-Hospital Postoperative Outcomes

“…To the Editor: Zalikha et al, 1 in their article, “Frailty Among Total Hip and Knee Arthroplasty Recipients: Epidemiology and Propensity Score-weighted Analysis of Effect on In-hospital Postoperative Outcomes,” reported that compared with a control group, “frail patients were found to have increased risk of any postoperative complication.” In addition, frail patients had a longer length of stay. Frail patients were identified based on comorbidities, including muscle weakness, debility, muscle wasting, and disuse atrophy.…”

Frailty Among Total Hip and Knee Arthroplasty Recipients: Epidemiology and Propensity Score-Weighted Analysis of Effect on In-Hospital Postoperative Outcomes

“…In the original article, "Frailty Among Total Hip and Knee Arthroplasty Recipients: Epidemiology and Propensity Score-weighted Analysis of Effect on In-hospital Postoperative Outcomes," we conducted a retrospective analysis of the National Inpatient Sample (NIS) to compare medical comorbidities and inpatient outcomes among primary total joint arthroplasty of the hip and knee (TJA) recipients with and without frailty. 1 As highlighted in Dr. Kuschner's letter, the cohort of interest was identified through a list of previously reported comorbidities. Given the nature of the study and the use of an administrative database, these comorbidities, and subsequently frail patients, were identified by mining the deidentified records for specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, as reported in the methods section.…”