Comparing the Predictors of Functional Outcomes After Arthroscopic Rotator Cuff Repair Modified Frailty Index, Clinical Frailty Scale, and Charlson Comorbidity Index

Abstract

Background: The incidence of rotator cuff tears increases with age, and operative management is usually required in patients with persistent symptoms. Although several studies have analyzed the effect of age and comorbidities on outcomes after rotator cuff repair, no study has specifically examined the consequence of frailty. Purpose: To determine the best frailty/comorbidity index for predicting functional outcomes after arthroscopic rotator cuff repair. Study Design: Cohort study; Level of evidence, 3. Methods: The authors conducted a retrospective cohort study of 340 consecutive patients who underwent unilateral arthroscopic rotator cuff repair at a tertiary hospital between April 2016 and April 2018. All patients had undergone arthroscopic double-row rotator cuff repair with subacromial decompression by a single fellowship-trained shoulder surgeon. Patient frailty was measured using the Modified Frailty Index (MFI), Clinical Frailty Scale (CFS), and Charlson Comorbidity Index (CCI), calculated through retrospective chart review based on case notes made just before surgery; patient age and sex were also noted preoperatively. Functional outcomes using the Oxford Shoulder Score (OSS), Constant Shoulder Score (CSS), University of California Los Angeles (UCLA) Shoulder Score, and visual analog scale for pain were measured preoperatively and at 3, 6, 12, and 24 months postoperatively. Results: The MFI was a consistent significant predictor in all functional outcome scores up to 24 months postoperatively ( P < .05), unlike the CFS and CCI. Sex was also a significant predictor of postoperative OSS, CSS, and UCLA Shoulder Score, with male sex being associated with better functional outcomes. Patients with higher MFI scores had slower functional improvement postoperatively, but they eventually attained functional outcome scores comparable with those of their counterparts with lower MFI scores at 24 months postoperatively. Conclusion: The MFI was found to be a better tool for predicting postoperative function than was the CFS or CCI in patients undergoing arthroscopic rotator cuff repair. The study findings suggest that a multidimensional assessment of frailty (including both functional status and comorbidities) is important in determining functional outcomes after arthroscopic rotator cuff repair.

Approaching Artificial Intelligence in Orthopaedics: Predictive Analytics and Machine Learning to Prognosticate Arthroscopic Rotator Cuff Surgical Outcomes

“…One might expect that pre-operative assessment scores would be inversely related to post-operative outcomes; that is, that higher pain and lower functional scores pre-operatively would predict worse post-operative outcomes. Likewise, several studies demonstrate this to be the case [ 25 , 26 , 27 , 28 ]. Conversely, we found lower pre-operative ASES and VAP scores to be the most significant predictors of post-operative ASES score improvement, with higher pre-operative values negatively influencing post-operative scores.…”

“…Our results did not demonstrate a strong association between gender and post-operative ASES scores, another area of conflicting findings in the literature. Several studies show female sex to be associated with worse post-operative quality of life, mental health, pain, and functional assessments [ 26 , 27 , 48 , 49 , 50 , 51 ]. Conversely, other studies demonstrate that gender does not influence post-operative outcomes [ 39 ].…”

Does a Modified Frailty Index Predict 30-day Complications After Long-Bone Nonunion or Malunion Surgery?

“…[4][5][6] Frailty is described as deterioration in physiological functioning beyond that attributable to age-related changes alone and has been found to be a more robust predictor of surgical outcomes than American Society of Anesthesiology (ASA) class and age in several studies. [7][8][9][10] There have been 2 main methods of assessing frailty, either operationalizing frailty as the number of comorbidities an individual has in the frailty index model or considering frailty as a syndrome manifested by motor symptoms and unintentional weight loss in the frailty phenotype model. [11][12][13] Several studies have demonstrated that the frailty index can better define the risk of adverse outcomes than the frailty phenotype model.…”

The Modified Five-Item Frailty Index to Predict Hand and Wrist Surgical Repair Postoperative Outcomes: An ACS-NSQIP Analysis of 11 369 Patients

“…The mFI-5 may be the newest iteration of a surgical risk proxy, but the question remains as to how its accuracy compares to the use of other single-item proxies such as age, 20 body mass index (BMI), 21 smoking status, 9 comorbidities, 20 ASA class, 22 and other recent risk proxies such as the Modified Charlson Comorbidity Index (mCCI). 23,24 Thus, the purpose of the present study is twofold: first, to evaluate if the mFI-5 can accurately forecast 30-day complication rates in HWSR using the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database. Second, to see how the mFI-5 compares to previously established proxies of surgical risk.…”