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Frailty may increase complications after total shoulder arthroplasty
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Frail patients may experience an increased risk of early complications and adverse outcomes after total shoulder arthroplasty, according to results.
Russell E. Holzgrefe , MD, and colleagues used Pearson analysis and linear regression to determine the association of the modified frailty index score with 30-day postoperative complications, reoperation, readmission, length of stay, adverse hospital discharge and mortality rate among 9,861 patients aged 50 years or older who underwent total shoulder arthroplasty (TSA).
Researchers found an increase in postoperative complications (4.2% to 9.4%), readmission (1.6% to 4.4%), adverse hospital discharge (6.3% to 19.6%) and length of stay (1.88 days to 2.43 days) as the modified frailty index score increased from 0 to 2 or more. Postoperative complications, readmissions, reoperations and adverse hospital discharge were more than twice as likely to occur among patients with a modified frailty index score of 2 or more, according to multivariate analysis. Compared with age, results showed these effects were all significantly higher.
“Our study demonstrates that increasing frailty is predictive of increased 30-day postoperative complications following total shoulder arthroplasty,” Holzgrefe told Healio.com/Orthopedics. “A simple frailty assessment using the five-item modified frailty index allows physicians to account for the heterogeneity of the elderly population’s physiologic reserve rather than relying on age alone as a surrogate. This has potential implications in providing individualized patient counseling and risk assessment, preoperative planning and medical optimization, and in risk stratification for emerging payment models.” – by Casey Tingle
Disclosure: Holzgrefe reports no relevant financial disclosures.
Perspective
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Ilya Voloshin, MD
The authors of the article “Modified frailty index is an effective risk-stratification tool for patients undergoing total shoulder arthroplasty” used the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to study association between five-item modified frailty index in patients undergoing total shoulder arthroplasty and patient outcomes. This retrospective analysis of prospectively collected data from the NSQIP database demonstrated that frailty is associated with increased rate of 30-day postoperative complications, reoperation, readmission, length of stay, adverse hospital discharge and mortality rate. These findings will help risk stratification in patients undergoing total shoulder arthroplasty.
Risk stratification is extremely relevant to modern medicine with changing reimbursement models and emphasis on patient-reported outcomes. It is critical to have accurate risk stratification for common orthopedic procedures to deliver high-quality care, better inform our patients and design accurate reimbursement models, especially in a bundled payments system. The federal government has been trying to control health care costs through non-reimbursable “never events,” which includes readmissions within 30 days after joint arthroplasty. Expansion of these measures are to be anticipated considering rising costs of health care. Efforts to account for “riskier” patients and procedures should be a major focus to try to decrease complications and devise accurate bundles for episodes of care.
Chief, shoulder and elbow division
University of Rochester, department of orthopedics
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