Subscribe to RSS
DOI: 10.1055/s-0044-1788295
Frailty is Superior to Age at Predicting Extended Length of Stay and Immediate Postoperative Complications Following Total Wrist Arthrodesis
![](https://www.thieme-connect.de/media/jws/EFirst/lookinside/thumbnails/10-1055-s-0044-1788295_2400040-1.jpg)
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.
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
-
References
- 1 Wei DH, Feldon P. Total wrist arthrodesis: indications and clinical outcomes. J Am Acad Orthop Surg 2017; 25 (01) 3-11
- 2 Laulan J, Marteau E, Bacle G. Wrist osteoarthritis. Orthop Traumatol Surg Res 2015; 101 (1, Suppl): S1-S9
- 3 Cavaliere CM, Chung KC. A systematic review of total wrist arthroplasty compared with total wrist arthrodesis for rheumatoid arthritis. Plast Reconstr Surg 2008; 122 (03) 813-825
- 4 Melamed E, Marascalchi B, Hinds RM, Rizzo M, Capo JT. Trends in the utilization of total wrist arthroplasty versus wrist fusion for treatment of advanced wrist arthritis. J Wrist Surg 2016; 5 (03) 211-216
- 5 Owen DH, Booth JW, Agius PA, Perriman DM, Smith PN, Roberts CJ. Union and complication rates after total wrist arthrodesis: a systematic review and meta-analysis. J Hand Surg Am 2023; (e-pub ahead of print) DOI: 10.1016/j.jhsa.2023.10.011.
- 6 Roulet S, Nguyen MV, Cohen G. et al. Total arthrodesis for non-rheumatoid wrists: outcomes at 5 and 20 years of follow-up. Orthop Traumatol Surg Res 2023; 109 (03) 103522
- 7 Kappenschneider T, Maderbacher G, Weber M. et al. Special orthopaedic geriatrics (SOG) - a new multiprofessional care model for elderly patients in elective orthopaedic surgery: a study protocol for a prospective randomized controlled trial of a multimodal intervention in frail patients with hip and knee replacement. BMC Musculoskelet Disord 2022; 23 (01) 1079
- 8 Vespa J, Armstrong DM, Medina L. Demographic Turning Points for the United States; Population Projections for 2020 to 2060. United States Census Bureau;
- 9 Serhal L, Lwin MN, Holroyd C, Edwards CJ. Rheumatoid arthritis in the elderly: characteristics and treatment considerations. Autoimmun Rev 2020; 19 (06) 102528
- 10 Deeken F, Sánchez A, Rapp MA. et al; Pawel Study Group. Outcomes of a delirium prevention program in older persons after elective surgery: a stepped-wedge cluster randomized clinical trial. JAMA Surg 2022; 157 (02) e216370
- 11 Traven SA, McGurk KM, Reeves RA, Walton ZJ, Woolf SK, Slone HS. Modified frailty index predicts medical complications, length of stay, readmission, and mortality following total shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28 (10) 1854-1860
- 12 Traven SA, Reeves RA, Althoff AD, Slone HS, Walton ZJ. New five-factor modified frailty index predicts morbidity and mortality in geriatric hip fractures. J Orthop Trauma 2019; 33 (07) 319-323
- 13 Traven SA, Reeves RA, Slone HS, Walton ZJ. Frailty predicts medical complications, length of stay, readmission, and mortality in revision hip and knee arthroplasty. J Arthroplasty 2019; 34 (07) 1412-1416
- 14 Pulik Ł, Jaśkiewicz K, Sarzyńska S, Małdyk P, Łęgosz P. Modified frailty index as a predictor of the long-term functional result in patients undergoing primary total hip arthroplasty. Reumatologia 2020; 58 (04) 213-220
- 15 Tolvi M, Tuominen-Salo H, Paavola M, Mattila K, Aaltonen LM, Lehtonen L. Root causes of extended length of stay and unplanned readmissions after orthopaedic surgery and hand surgery: a retrospective observational cohort study. Patient Saf Surg 2020; 14 (01) 27
- 16 Khan NA, Quan H, Bugar JM, Lemaire JB, Brant R, Ghali WA. Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gen Intern Med 2006; 21 (02) 177-180
- 17 Armaghani SJ, Lee DS, Bible JE. et al. Increased preoperative narcotic use and its association with postoperative complications and length of hospital stay in patients undergoing spine surgery. Clin Spine Surg 2016; 29 (02) E93-E98
- 18 Gulur P, Williams L, Chaudhary S, Koury K, Jaff M. Opioid tolerance–a predictor of increased length of stay and higher readmission rates. Pain Physician 2014; 17 (04) E503-E507
- 19 Lin LY, Hung TC, Lai YH. Pain control and related factors in hospitalized patients. Medicine (Baltimore) 2021; 100 (30) e26768
- 20 Althoff AD, Reeves RA, Traven SA, Slone HS, Deal DN, Werner BC. Risk factors for infection following total wrist arthroplasty and arthrodesis: an analysis of 6641 patients. Hand (N Y) 2021; 16 (05) 657-663
- 21 Hazewinkel MHJ, Lans J, Lunn KN, Garg R, Eberlin KR, Chen NC. Complications and factors associated with reoperation following total wrist fusion. J Wrist Surg 2020; 9 (06) 498-508
- 22 Rothenberg KA, Stern JR, George EL. et al. Association of frailty and postoperative complications with unplanned readmissions after elective outpatient surgery. JAMA Netw Open 2019; 2 (05) e194330
- 23 Vatic M, von Haehling S, Ebner N. Inflammatory biomarkers of frailty. Exp Gerontol 2020; 133: 110858
- 24 Subramaniam S, Aalberg JJ, Soriano RP, Divino CM. New 5-factor modified frailty index using American College of Surgeons NSQIP data. J Am Coll Surg 2018; 226 (02) 173-181.e8
- 25 Wilson JM, Holzgrefe RE, Staley CA, Schenker ML, Meals CG. Use of a 5-item modified frailty index for risk stratification in patients undergoing surgical management of distal radius fractures. J Hand Surg Am 2018; 43 (08) 701-709
- 26 Ibelli TJ, Alerte E, Akhavan A. et al. The modified five-item frailty index to predict hand and wrist surgical repair postoperative outcomes: an ACS-NSQIP analysis of 11 369 patients. Hand (N Y) 2024; 19 (03) 433-441
- 27 Goodman AD, Gil JA, Starr AM, Akelman E, Weiss AC. Thirty-day reoperation and/or admission after elective hand surgery in adults: a 10-year review. J Hand Surg Am 2018; 43 (04) 383.e1-383.e7
- 28 Lipira AB, Sood RF, Tatman PD, Davis JI, Morrison SD, Ko JH. Complications within 30 days of hand surgery: an analysis of 10,646 patients. J Hand Surg Am 2015; 40 (09) 1852-59.e3
- 29 Dasgupta M, Rolfson DB, Stolee P, Borrie MJ, Speechley M. Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr 2009; 48 (01) 78-83
- 30 Chen CL, Chen CM, Wang CY. et al. Frailty is associated with an increased risk of major adverse outcomes in elderly patients following surgical treatment of hip fracture. Sci Rep 2019; 9 (01) 19135
- 31 Hustedt JW, Chung A, Bohl DD. Development of a risk stratification scoring system to predict general surgical complications in hand surgery patients. J Hand Surg Am 2018; 43 (07) 641-648.e6
- 32 Bauer M, Fitzgerald L, Haesler E, Manfrin M. Hospital discharge planning for frail older people and their family. Are we delivering best practice? A review of the evidence. J Clin Nurs 2009; 18 (18) 2539-2546
- 33 Gane EM, Schoeb V, Cornwell P, Cooray CR, Cowie B, Comans TA. Discharge planning of older persons from hospital: comparison of observed practice to recommended best practice. Healthcare (Basel) 2022; 10 (02) 202