Anand Dayama1, Odunayo Olorunfemi2, Simon Greenbaum2, Melvin E Stone2, John McNelis2. 1. Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; San Joaquin General Hospital, UC Davis, 500 W Hospital Rd, French Camp, CA 95231, USA. Electronic address: dayama.md@gmail.com. 2. Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Abstract
INTRODUCTION: Frailty is a clinical state of increased vulnerability resulting from aging-associated decline in physiologic reserve. Hip fractures are serious fall injuries that affect our aging population. We retrospectively sought to study the effect of frailty on postoperative outcomes after Total Hip Arthroplasty (THA) and Hemiarthroplasty (HA) for femoral neck fracture in a national data set. METHODS: National Surgical Quality Improvement Project dataset (NSQIP) was queried to identify THA and HA for a primary diagnosis femoral neck fracture using ICD-9 codes. Frailty was assessed using the modified frailty index (mFI) derived from the Canadian Study of Health and Aging. The primary outcome was 30-day mortality and secondary outcomes were 30-day morbidity and failure to rescue (FTR). We used multivariate logistic regression to estimate odds ratio for outcomes while controlling for confounders. RESULTS: Of 3121 patients, mean age of patients was 77.34 ± 9.8 years. The overall 30-day mortality was 6.4% (3.2%-THA and 7.2%-HA). One or more severe complications (Clavien-Dindo class-IV) occurred in 7.1% patients (6.7%-THA vs.7.2%-HA). Adjusted odds ratios (ORs) for mortality in the group with the higher than median frailty score were 2 (95%CI, 1.4-3.7) after HA and 3.9 (95%CI, 1.3-11.1) after THA. Similarly, in separate multivariate analysis for Clavien-Dindo Class-IV complications and failure to rescue 1.6 times (CI95% 1.15-2.25) and 2.1 times (CI95% 1.12-3.93) higher odds were noted in above median frailty group. CONCLUSIONS: mFI is an independent predictor of mortality among patients undergoing HA and THA for femoral neck fracture beyond traditional risk factors such as age, ASA class, and other comorbidities. LEVELS OF EVIDENCE: Level II.
INTRODUCTION: Frailty is a clinical state of increased vulnerability resulting from aging-associated decline in physiologic reserve. Hip fractures are serious fall injuries that affect our aging population. We retrospectively sought to study the effect of frailty on postoperative outcomes after Total Hip Arthroplasty (THA) and Hemiarthroplasty (HA) for femoral neck fracture in a national data set. METHODS: National Surgical Quality Improvement Project dataset (NSQIP) was queried to identify THA and HA for a primary diagnosis femoral neck fracture using ICD-9 codes. Frailty was assessed using the modified frailty index (mFI) derived from the Canadian Study of Health and Aging. The primary outcome was 30-day mortality and secondary outcomes were 30-day morbidity and failure to rescue (FTR). We used multivariate logistic regression to estimate odds ratio for outcomes while controlling for confounders. RESULTS: Of 3121 patients, mean age of patients was 77.34 ± 9.8 years. The overall 30-day mortality was 6.4% (3.2%-THA and 7.2%-HA). One or more severe complications (Clavien-Dindo class-IV) occurred in 7.1% patients (6.7%-THA vs.7.2%-HA). Adjusted odds ratios (ORs) for mortality in the group with the higher than median frailty score were 2 (95%CI, 1.4-3.7) after HA and 3.9 (95%CI, 1.3-11.1) after THA. Similarly, in separate multivariate analysis for Clavien-Dindo Class-IV complications and failure to rescue 1.6 times (CI95% 1.15-2.25) and 2.1 times (CI95% 1.12-3.93) higher odds were noted in above median frailty group. CONCLUSIONS: mFI is an independent predictor of mortality among patients undergoing HA and THA for femoral neck fracture beyond traditional risk factors such as age, ASA class, and other comorbidities. LEVELS OF EVIDENCE: Level II.
Authors: Lauren Jan Gleason; Emily A Benton; M Loreto Alvarez-Nebreda; Michael J Weaver; Mitchel B Harris; Houman Javedan Journal: J Am Med Dir Assoc Date: 2017-08-31 Impact factor: 4.669
Authors: Cornelis L P van de Ree; Maud J F Landers; Nena Kruithof; Leonie de Munter; Joris P J Slaets; Taco Gosens; Mariska A C de Jongh Journal: BMJ Open Date: 2019-07-18 Impact factor: 2.692