TY - JOUR
T1 - How Is Surgical Risk Best Assessed? A Cohort Comparison of Measures in Total Joint Arthroplasty
AU - Johnson, Rebecca L.
AU - Habermann, Elizabeth B.
AU - Johnson, Madeline Q.
AU - Abdel, Matthew P.
AU - Chamberlain, Alanna M.
AU - Mantilla, Carlos B.
N1 - Funding Information:
This project was supported by the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery award, Mayo Clinic Department of Development Benefactor Gift, and through the Department of Anesthesiology and Perioperative Medicine Small Grants Program. The authors wish to acknowledge the Anesthesia Clinical Research Unit and the expert program analysts within Health Sciences Research Departments at Mayo Clinic, Rochester, MN.
Funding Information:
This project was supported by the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery award, Mayo Clinic Department of Development Benefactor Gift, and through the Department of Anesthesiology and Perioperative Medicine Small Grants Program. The authors wish to acknowledge the Anesthesia Clinical Research Unit and the expert program analysts within Health Sciences Research Departments at Mayo Clinic, Rochester, MN. Special recognition to Mr. Ryan D. Frank within the Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN for his work on statistical analyses and manuscript preparation. Additionally, we wish to recognize Ms Youlonda Loechler and Dr. Christopher Salib within the Department of Orthopedic Surgery for their expertise in data contained within the Total Joint Registry. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/3
Y1 - 2021/3
N2 - Background: We designed this study to determine whether a Frailty Deficit Index (FI) confers added risk stratification beyond more traditional methods. The associations of preoperative scores on FI, American Society of Anesthesiologists (ASA) physical status, and Charlson Comorbidity Index (CCI) with complications after total joint arthroplasty (TJA) were compared. Methods: Using a single institution cohort of adult patients ≥50 years undergoing primary or revision TJA from 2005 to 2016, we assessed how well the FI, CCI, and ASA scores predicted risk of mortality, infection, and reoperation. We performed 7 models for each outcome: FI, ASA, and CCI alone, FI + ASA, FI + CCI, ASA + CCI, and FI + ASA + CCI. Cox proportional hazards regression methods were used to calculate the concordance (C-) statistic, a measure of discrimination. Results: Of 18,397 TJAs included, 98.9% were alive 1 year postoperatively. For mortality, all models had concordance between 0.76 and 0.79, with the FI + ASA + CCI model performing highest (C-statistic 0.79; 95% confidence interval [CI] 0.76-0.82). Unadjusted, FI had the strongest concordance (C-statistic 0.77). In FI + ASA + CCI, each increase in 1 comorbidity (of 32 total comorbidities) in the FI was significantly associated with a 12% increase in the rate of mortality (hazard ratio [HR] 1.12, 95% CI 1.07-1.17, P < .001), 10% increase in infection (HR 1.10, 95% CI 1.06-1.14; P < .001), and 6% increase in reoperation (HR 1.06, 95% CI 1.05-1.08, P < .001). Conclusion: Identifying at-risk patients preoperatively is crucial and may result in adjustment of postoperative care. FI was independently associated with risk of adverse outcomes following TJA even after taking into account other predictive measures.
AB - Background: We designed this study to determine whether a Frailty Deficit Index (FI) confers added risk stratification beyond more traditional methods. The associations of preoperative scores on FI, American Society of Anesthesiologists (ASA) physical status, and Charlson Comorbidity Index (CCI) with complications after total joint arthroplasty (TJA) were compared. Methods: Using a single institution cohort of adult patients ≥50 years undergoing primary or revision TJA from 2005 to 2016, we assessed how well the FI, CCI, and ASA scores predicted risk of mortality, infection, and reoperation. We performed 7 models for each outcome: FI, ASA, and CCI alone, FI + ASA, FI + CCI, ASA + CCI, and FI + ASA + CCI. Cox proportional hazards regression methods were used to calculate the concordance (C-) statistic, a measure of discrimination. Results: Of 18,397 TJAs included, 98.9% were alive 1 year postoperatively. For mortality, all models had concordance between 0.76 and 0.79, with the FI + ASA + CCI model performing highest (C-statistic 0.79; 95% confidence interval [CI] 0.76-0.82). Unadjusted, FI had the strongest concordance (C-statistic 0.77). In FI + ASA + CCI, each increase in 1 comorbidity (of 32 total comorbidities) in the FI was significantly associated with a 12% increase in the rate of mortality (hazard ratio [HR] 1.12, 95% CI 1.07-1.17, P < .001), 10% increase in infection (HR 1.10, 95% CI 1.06-1.14; P < .001), and 6% increase in reoperation (HR 1.06, 95% CI 1.05-1.08, P < .001). Conclusion: Identifying at-risk patients preoperatively is crucial and may result in adjustment of postoperative care. FI was independently associated with risk of adverse outcomes following TJA even after taking into account other predictive measures.
KW - activities of daily living
KW - frailty
KW - outcomes
KW - perioperative complications
KW - total joint arthroplasty
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U2 - 10.1016/j.arth.2020.09.046
DO - 10.1016/j.arth.2020.09.046
M3 - Article
C2 - 33071030
AN - SCOPUS:85092671020
SN - 0883-5403
VL - 36
SP - 851-856.e3
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 3
ER -