Frailty, as quantified by the modified frailty index (mFI), has emerged as a promising method to identify patients at high risk of complications after surgery. Several studies have shown that frailty, as opposed to age, is more predictive of adverse surgical outcomes. These authors hypothesized that a 5-item mFI could be used to identify patients at elevated risk of complications after total shoulder arthroplasty (TSA).
They identified 9861 patients aged 50 years or older (mean 70 years) who underwent TSA in the American College of Surgeons National Surgical Quality Improvement Program database. They determined the association of the mFI score with 30-day postoperative complications, reoperation, readmission, length of stay (LOS), adverse hospital discharge, and mortality rate.
As the mFI score increased from 0 to 2 or greater, the following rates increased: postoperative complications from 4.2% to 9.4%, readmission from 1.6% to 4.4%, adverse hospital discharge from 6.3% to 19.6%, and LOS from 1.88 days to 2.43 days (P<.001).
Multivariate analysis showed that patientswith an mFI score of 2 or greater were over twice as likely to sustain a postoperative complication (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.86-3.10), readmission (OR, 2.80; 95% CI, 1.88-4.17), reoperation (OR, 1.82; 95% CI, 1.02-3.25), and adverse hospital discharge (OR, 3.14; 95% CI, 2.51-3.92).
The authors provided an easy way to remember the five components of the score
Comment: While some have recommended using lab tests as a measure of frailty, these authors have shown that five easy-to-determine elements of the patient's history can help predict the risk of 30 day complications.
It is also a useful reminder to see that one in 25 total shoulder patients over the age of 50 and one in 17 patients over the age of 70 experienced a complication.
It is also a useful reminder to see that one in 25 total shoulder patients over the age of 50 and one in 17 patients over the age of 70 experienced a complication.
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