Ten-year epidemiological study in an orthopaedic and trauma surgery centre: Are there risks involved in increasing scheduled arthroplasty volume without increasing resources?

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Abstract

[Indexed for MEDLINE] 16. J Arthroplasty. 2019 Jan;34(1):56-64.e5. doi: 10.1016/j.arth.2018.09.078. Epub 2018 Sep 25. Impact of Frailty on Outcomes After Primary and Revision Total Hip Arthroplasty. Johnson RL(1), Abdel MP(2), Frank RD(3), Chamberlain AM(4), Habermann EB(4), Mantilla CB(1). Author information: (1)Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. (2)Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota. (3)Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota. (4)Department of Health Services Research, Mayo Clinic College of Medicine, Rochester, Minnesota. BACKGROUND: Frailty and disability from arthritis are closely intertwined and little is known about the impact of frailty on total hip arthroplasty (THA) outcomes. We hypothesized that higher preoperative frailty is associated with more adverse events following THA. METHODS: All patients (≥50 years) undergoing unilateral primary or revision THA at a single institution from 2005 through 2016 were included. We analyzed the association of frailty (measured by a frailty deficit index) with postoperative outcomes in hospital, within 90 days, and within 1 year using multivariable logistic and Cox regression, adjusting for age. RESULTS: Among 8640 patients undergoing THA (6502 primary and 2138 revisions; median age 68 years), 22.7%, 32.9%, and 44.4% were classified as frail, vulnerable, and nonfrail, respectively. Frail patients tended to be female, older, sicker (American Society of Anesthesiologists ≥3), and received general anesthesia more frequently. Relative to nonfrail patients, frail patients had significantly increased odds of wound complications/hematoma (odds ratio 2.01) and reoperation (odds ratio 2.74) while in hospital, and increased risks for mortality (1-year hazards ratio [HR] 5.65), infection (1-year HR 3.63), dislocation (1-year HR 2.10), wound complications/hematoma (1-year HR 2.61), and reoperation (1-year HR 2.22) within 90 days and 1 year. Frailty was also associated with >5.5-fold increased mortality risk 1 year following THA. No significant associations with aseptic loosening, periprosthetic fracture, or heterotopic ossification were observed. CONCLUSION: A higher preoperative frailty index is associated with increased mortality and perioperative complications following primary and revision THA. The proposed frailty deficit index provides clinically important information for healthcare providers to use when counseling patients prior to decision for surgery. Copyright © 2018 Elsevier Inc. All rights reserved. DOI: 10.1016/j.arth.2018.09.078