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J Wrist Surg
DOI: 10.1055/s-0044-1788295
Clinical Research Article

Frailty is Superior to Age at Predicting Extended Length of Stay and Immediate Postoperative Complications Following Total Wrist Arthrodesis

Victor Koltenyuk 
1   School of Medicine, New York Medical College, Valhalla, New York
,
Matthew Merckling
1   School of Medicine, New York Medical College, Valhalla, New York
,
Michael Li
1   School of Medicine, New York Medical College, Valhalla, New York
,
Ian Jarin
2   Department of Orthopaedic Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York
,
Matthew Konigsberg
2   Department of Orthopaedic Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York
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Abstract

Hypothesis The modified five-factor frailty index (mFI-5) is a better predictor than age alone of increased risk of extended length of stay (LOS) and postoperative complications in patients undergoing total wrist arthrodesis (TWA).

Methods The National Inpatient Sample database was queried for patients undergoing elective TWA. Patients were identified using the International Classification of Diseases, 10th Revision procedure codes, excluding nonelective cases, hardware removal, and patients with cerebral palsy or seizure disorders. Frailty was assessed by identifying the variables used in the mFI-5 and patients were categorized as nonfrail (mFI-5 = 0), prefrail (mFI-5 = 1), and frail (mFI-5 ≥ 2). Outcomes assessed included LOS and immediate postoperative complications such as nausea and vomiting requiring admission, acute kidney injury, postoperative hypotension, postoperative hypothyroidism, and urinary tract infection. Logistic regression was used to analyze the association between frailty status and both extended LOS and immediate postoperative complications.

Results Between 2015 and 2019, 685 patients underwent TWA, with 49.6% not frail, 33.5% prefrail, and 16.7% frail. Prefrail and frail patients were at increased risk of undergoing extended LOS (OR 2.182, p = 0.001; OR 2.312, p = 0.002, respectively). Age over 65 (OR 1.995, p < 0.001) and female sex (OR 1.605, p = 0.029) were also independent risk factors. Frail patients were found to have an increased likelihood of acquiring any postoperative complication (OR 3.865, p < 0.001), while elderly age was not a significant risk factor (OR 1.361, p = 0.298). Using receiver operating characteristic (ROC) curve analysis, the mFI-5 demonstrated superior discriminatory ability compared with age for extended LOS (Area under the curve (AUC) 0.729 vs. 0.542) and postoperative complications (AUC 0.712 vs. 0.673).

Conclusion Our study demonstrates that both elderly age and frailty are independent predictors of extended hospitalization following TWA, while frailty but not age, is a significant predictor of immediate postoperative complications. To our knowledge, our study is the first to report an association between frailty status and immediate postoperative complications following TWA. Incorporating a preoperative frailty screening can allow for more open and informed preoperative discussion about surgical risk for elective procedures such as TWA, as well as allow for enhanced postoperative planning.

Keywords

wrist arthrodesis - frailty - length of stay - postoperative complications

Supplementary Material



Publication History

Received: 28 March 2024

Accepted: 10 June 2024

Article published online:
17 July 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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