Frailty as a predictor of hospital length of stay after elective total joint replacements in elderly patients

Abstract

BackgroundTotal joint replacement procedures are increasing in number because of population aging and osteoarthritis development. Defined as a lack of physiological reserves and the inability to adequately respond to external stressors, frailty may be more common than expected in older patients with degenerative arthritis awaiting total joint replacements.The aim of the present study was to assess associations between frailty and adverse outcomes, frailty prevalence among elderly patients awaiting elective TJR, and agreement between 2 frailty screening instruments.MethodsWe undertook a prospective, observational, pilot study in our institution. We enrolled patients 65 years or older who were awaiting elective knee or hip replacement surgery and evaluated them in our preoperative clinic with planned postoperative hospital length of stay greater than 24 h. Patients were asked to grade their perceived well-being on the Clinical Frailty Scale and to answer questions on the FRAIL Scale.ResultsThe Clinical Frailty Scale classified 40 patients (45.9%) as robust, 43 patients (49.4%) as prefrail and 4 patients (4.5%) as frail, while the FRAIL Scale categorized 12 patients (13.7%) as robust, 54 patients (62.0%) as prefrail, and 20 patients (22.9%) as frail. Robustness, ascertained on the Clinical Frailty Scale was, while the FRAIL Scale was not, significantly associated with shorter hospital length of stay and fewer discharges to the rehabilitation center. Both scales showed moderate mutual agreement.ConclusionScreening for frailty identified between 5% and 10% of patients at risk of adverse outcomes. The Clinical Frailty Scale was, while the FRAIL scale was not, significantly associated with hospital length of stay and discharge to rehabilitation center in our cohort of total joint replacement patients.

Patients with life‐limiting illness presenting to the emergency department

“…17 Our study used the Clinical Frailty score as the frailty assessment tool. The Clinical Frailty score is well validated, [18][19][20][21][22] with Clinical Frailty score, the Frailty Index and the Frailty Phenotype the most commonly used frailty tools. 23 A systematic review looking at screening of frail patients in the ED found only four studies meeting the inclusion criteria and concluded that more randomised clinical trials of frailty screening tools compared to usual care are clearly needed.…”

Preoperative Evaluation of the Frail Patient

“…12,38 One study using 2 different frailty assessment tools in elective total joint replacement patients showed that the frailty status categorized by the CFS was significantly associated with LOS while those categorized by FRAIL scale was not. 42 The CFS is based on the deficit accumulation model, 18 and the FRAIL scale is based more on Fried's phenotypic model. 20,42 The authors postulated that their study population, which consisted of elective orthopedic surgery patients, may have excluded more frail patients (eg, the hip fracture population).…”

Predicting hospital outcomes with the reported edmonton frail scale‐Thai version in orthopaedic older patients

“…In addition, LOS might have been increased because of other factors, such as the type of surgery and/or postoperative adverse events or intraoperative incidence. Hip, knee and spine surgery are complicated surgeries that often result in adverse events or postoperative complications, and extended LOS in frail patients is well documented Wang et al, 2018). 18Complications/adverse events, n (%) 53 265Postoperative delirium (POD), n (%) 25 12524 hour-postoperative 13 52Discharge day 12 48Discharge disposition, n (%) of inability to discharge home 22 (11%)…”