Does preoperative frailty index screening predict postoperative outcomes in geriatric total knee and hip arthroplasty patients?

Principal Investigator: Antonia Chen

Authors: Prabhavi Denagamage, Daniel Lamanna, Brielle Antonelli, Antonia Chen
Lay Abstract

Introduction
The Comprehensive Geriatric Assessment (CGA) frailty index (FI) takes essential predictors of postoperative health into account. The purpose of this study was to identify how FI correlates to adverse postoperative outcomes in geriatric total joint arthroplasty (TJA) patients.

Methods
Geriatric TJA patients (70-90 years old) were assessed using the CGA FI and Short Physical Performance Battery (SPPB) Protocol. Preoperative, day of surgery, and one-year postoperative data were collected.

Linear regression and Student’s T-test were used to assess the association between preoperative FI score versus hospital length of stay, postoperative SPPB score, discharge location, and rate of readmission and emergency department visits within 90 days of surgery.

Results
Discharge location (p=0.0043) and postoperative SPPB score (p<0.0001) were significantly associated with preoperative FI score. Patients discharged to home had a significantly different preoperative FI score (0.19) compared to those discharged to rehab (0.3)-lower scores indicate lesser frailty. For every 1 unit increase in preoperative FI score, there was a 16.08 unit decrease in postoperative SPPB score.

Conclusion
TJA patients who were less frail (higher FI) were more likely to go home and have higher post-operative function. Improving patient’s FI prior to surgery may improve patient outcomes.

Scientific Abstract

Introduction
The Comprehensive Geriatric Assessment (CGA) frailty index (FI) takes essential predictors of postoperative health into account. The purpose of this study was to identify how FI correlates to adverse postoperative outcomes in geriatric total joint arthroplasty (TJA) patients.

Methods
Geriatric TJA patients (70-90 years old) were assessed using the CGA FI and Short Physical Performance Battery (SPPB) Protocol. Preoperative, day of surgery, and one-year postoperative data were collected.

Linear regression and Student’s T-test were used to assess the association between preoperative FI score versus hospital length of stay, postoperative SPPB score, discharge location, and rate of readmission and emergency department visits within 90 days of surgery.

Results
Discharge location (p=0.0043) and postoperative SPPB score (p<0.0001) were significantly associated with preoperative FI score. Patients discharged to home had a significantly different preoperative FI score (0.19) compared to those discharged to rehab (0.3)-lower scores indicate lesser frailty. For every 1 unit increase in preoperative FI score, there was a 16.08 unit decrease in postoperative SPPB score.

Conclusion
TJA patients who were less frail (higher FI) were more likely to go home and have higher post-operative function. Improving patient’s FI prior to surgery may improve patient outcomes.

Clinical Implications
The Comprehensive Geriatric Assessment Frailty Index takes into account essential predictors of post-operative health. Using this, healthcare providers can improve TJA outcomes by providing specific treatment and care plans prior to surgery.

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