Frailty measurements in hospitalised orthopaedic populations age 65 and older: A scoping review

Roopsawang, Inthira; Zaslavsky, Oleg; Thompson, Hilaire J.; Aree‐Ue, Suparb; Kwan, Rick Yiu Cho; Belza, Basia

doi:10.1111/jocn.16035

Cited by 22 publications

(22 citation statements)

References 58 publications

(101 reference statements)

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“…Wahl et al [10] studied the association of MFI with 30 days' surgical readmissions in orthopedics, general surgery, and vascular surgeries. Roopsawang et al [11] studied various frailty measurements in orthopedic populations aged more than 65 years and concluded that various frailty indices have been used in the orthopedic setting; however, evidence is still lacking for the gold standard frailty index. We feel that since frailty is subjective and difficult to measure, it is difficult to get an ideal frailty index.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Study Correlating Preoperative Modified Frailty Index With One-Year Mortality in the Elderly With Hip Fractures

Daddimani¹,

Murthy²,

Sharan³

et al. 2022

Cureus

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BackgroundHip fractures occur frequently in the elderly population over the age of 60 years following low-energy domestic falls. The postoperative mortality after hip fracture surgery depends on numerous factors like comorbidities, pre-fall ambulatory status, nutritional status, cognition, and overall physical health. In this context, the physiological age and reserve play a vital role in mortality after hip fracture surgeries. This physiological reserve is measured in terms of "frailty." There are many frailty indices that assess the physiological reserves of an elderly patient. The modified frailty index (MFI) is one of the validated indexes predicting postoperative complications and mortality. So we concluded there is a need to assess the patients with MFI preoperatively, based on which mortality and postoperative complications could be predicted in our patients. Materials and methodsWe included 100 patients aged more than 60 years with intertrochanteric and neck of the femur fractures, who were managed surgically. We followed the patients for one year and observed the immediate and late complications and mortality at the end of one year. To reduce bias, patients with pathological fractures, revision surgeries, contralateral fractures, high-energy trauma, younger than 60 years of age, and previous proximal femur fracture surgery on the side of injury were excluded from the study. ResultsThe primary objective was to study the correlation between the MFI with one-year mortality. We observe that the MFI score had a significant effect on mortality at one year (p-value = 0.0316). With a unit increase in the MFI score, the odds of death increase by a factor of 1.52. ConclusionThere is a strong correlation between MFI with one-year mortality and postoperative complications after hip fracture surgeries in the elderly. This MFI can be used as a preoperative predictive model to predict the mortality and postoperative complications after hip fractures in the elderly. It will also help patients and their caretakers in decision-making and elucidating surgery choices.

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Section: Introductionmentioning

confidence: 99%

A Prospective Study Correlating Preoperative Modified Frailty Index With One-Year Mortality in the Elderly With Hip Fractures

Daddimani¹,

Murthy²,

Sharan³

et al. 2022

Cureus

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“…While it is widely accepted that increased age serves as an indicator to predict postoperative complications, however, because the heterogeneity of different population, some younger people can be frail, and some older people can be robust. 16 In recent years, the 5-item Fried frailty phenotype was one of the most commonly used indexes evaluating 22 Nevertheless, on the one hand, in previous literatures, comparing frailty and age, the superiority of predicting postoperative complications was the focus. In a retrospective analysis of 199 patients, Leung et al 23 demonstrated that age was a significant moderator of the relationship between pre-frail and body measures.…”

Section: Discussionmentioning

confidence: 99%

“… 16 In recent years, the 5-item Fried frailty phenotype was one of the most commonly used indexes evaluating postoperative outcomes. 22 Nevertheless, on the one hand, in previous literatures, comparing frailty and age, the superiority of predicting postoperative complications was the focus. In a retrospective analysis of 199 patients, Leung et al 23 demonstrated that age was a significant moderator of the relationship between pre-frail and body measures.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Frailty on Perioperative Outcomes in Patients Receiving Short-Level Posterior Lumbar Interbody Fusion: A Stepwise Propensity Score Matching Analysis

Cui¹,

Wang²,

Wang³

et al. 2022

CIA

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Background: There are many studies on the impact of frailty on postoperative complications; however, there are few studies focusing on stepwise propensity score matching (PSM) to offset the influence of age. Methods: We gathered data for patients undergoing short-level posterior lumbar interbody fusion from January to December 2021. According to the Fried frailty phenotype, we categorized patients into non-frail, pre-frail, and frail groups, then, stepwise PSM for age, sex, American Society of Anesthesiologists (ASA) and fusion levels were performed to keep comparable clinical data between groups. Univariate and multivariate logistic regressions were used to determine the impact of clinical demographics on postoperative complications. Results: A total of 559 consecutive patients with complete medical records were enrolled (237 males and 322 females; mean age 72.55 ± 5.86 years). After PSM, we found that pre-frail patients were more vulnerable to develop urinary retention (p = 0.031) and surgical site infections (p = 0.021) than non-frail patients. Longer length of stay (LOS), delayed ambulation and removal of urinary catheter times were observed in pre-frail patients. However, there was a significant difference only in LOS between pre-frail and frail patients. Binary logistic regression revealed that C-reactive protein (CRP) and frail status were independently associated with postoperative complications between non-frail and pre-frail patients, while only CRP was independently correlated with complications between pre-frail and frail patients. Conclusion: After PSM, we found higher rates of urinary retention and surgical site infections in pre-frail patients than in non-frail patients. CRP was independently related to postoperative complications, while frail status was only independently associated with postoperative complications between pre-frail and non-frail patients. Pre-frail/frail patients tended to have more severe stress responses than non-frail patients.

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“…While it is widely accepted that increased age serving as an indactor to predict postoperative complications, however, because the heterogeneity of different population, some younger people can be frail, and some older people can be robust [16]. In recent years, frailty, as distinguished by 5-item Fried frailty phenotype was one of the most commonly uesd to evaluate postoperative outcomes [22]. Nevertheless, on one hand, in previous literatures, comparing frailty and age the superiority to predict postoperative complications was the focus.…”

Section: Discussionmentioning

confidence: 99%

The impact of frailty on perioperative outcomes in patients receiving short-level posterior lumbar interbody fusion: a stepwise propensity score matching analysis

Cui

Wang

et al. 2022

Preprint

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Background There were many literatures reporting the impact of frailty on postoperative complications, however, studies according to stepwise propensity score matching (PSM) to offset the influence of age were limited.Methods We gathered data for all patients undergoing short-level posterior lumbar interbody fusion from January to December 2021. Accroding to Fried frailty phenotype, we segragated patients into three groups (not-frailty, pre-frailty, and frailty), then, stepwise propensity score matching for age, sex, American Society of Anesthesiologists (ASA) and fusion levels were performed to keep comparable clinical data between groups. Uni- and multivariate logistic regression were used to identify the impact of clinical demographics on postoperative complications.Results A total consecutive 559 patients with complete medical records were enrolled (237 males and 322 females; mean age 72.55 ± 5.86 years). After PS matching, we found pre-frail patients were more vulnerable to develop urinary retention ( p = 0.031 ) and surgical site infection ( p = 0.021 ) than non-frail patients. Meanwhile, longer length of stay (LOS), ambulation time and removal of urinary catheter time were observed in pre-frail patients. However, there was significant difference only in LOS between pre-frail and frail patients. Binary logistic regression revealed that C-reaction protein (CRP) and frailty status were independently associated with postoperative complications between non-frail and pre-frail patients, while only CRP was independently correlated with that of between pre-frail and frail patients.Conclusions In this study, after PS matching, we found higher rate of urinary retention and surgical site infection in pre-frail patients than that of non-frail patients. CRP was independently related to postoperative complications, while frailty status was only independently associated with postoperative complications between pre-frail and non-frail patients. And pre-frail/frail patients tended to have severer stress response than that of non-frail patients.

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Frailty measurements in hospitalised orthopaedic populations age 65 and older: A scoping review

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 22 publications

References 58 publications

A Prospective Study Correlating Preoperative Modified Frailty Index With One-Year Mortality in the Elderly With Hip Fractures

A Prospective Study Correlating Preoperative Modified Frailty Index With One-Year Mortality in the Elderly With Hip Fractures

The Impact of Frailty on Perioperative Outcomes in Patients Receiving Short-Level Posterior Lumbar Interbody Fusion: A Stepwise Propensity Score Matching Analysis

The impact of frailty on perioperative outcomes in patients receiving short-level posterior lumbar interbody fusion: a stepwise propensity score matching analysis

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