Frailty Is An Independent Predictor Of Postoperative Complications After Elective Elderly Orthopedic Surgery

Objective To investigate the association between frailty and comprehensive complication index(CCI)in the elderly patients undergoing elective orthopedic surgery,providing a new theoretical basis and an important intervention target for the prevention and treatment of postoperative complications.Methods A prospective study was finally conducted on 320 patients over 65 who underwent elective orthopedic surgeries between December 2018 and June 2019 in Jinling Hospital.Frailty of every patient was evaluated by the Edmonton Frail Scale(EFS)at admission by an anesthesiologist who did not participate in our research.The EFS is a validated tool that provides a global assessment on the basis of some basic questions to determine the patient's level of frailty,ranging from 0(not frail)to 17(very frail),which can be done by a non-geriatrician within 5 min.An increase in the total score suggests an increase in the severity of frailty,with a score of 0 to 7 being classified as non-frail and 8 to 17 as frail.Of the total population studied,111 patients(34.7%)were classified as frail(EFS ? 8).The following parameters were investigated: preoperative parameters such as EFS,age,sex,body mass index(BMI),educational years,American Society of Anesthesiologists(ASA)Grade,mini-mental state examination(MMSE),Charlson Comorbidity Index,basic activities of daily living(BADL),instrumental activities of daily living(IADL),albumin(Alb),interleukin-6(IL-6);intraoperative parameters such as blood loss,duration of surgery;and postoperative parameters and outcomes such as CCI of the first 30 postoperative days(30d-CCI),hospital stay,readmission to hospital in the first 30 postoperative days(30d-readmission).Laboratory and clinical data were collected by reviewing digital medical records.Follow-up data for 30 days after surgery were obtained by telephone.The analyses of the effect of EFS on postoperative complications(CCI)were adjusted for potentially significant preoperative confounding factors by using a preselection.That is,univariate analysis was performed on all potential variables when CCI was used as the dependent variable,and then multivariate analysis was performed by using the most significant variables(P < 0.1)to evaluate the association between frailty and 30-day postoperative outcomes.Results The mean frailty score was 6.8 ± 3.2 points and mean CCI was 15.3 ± 18.8 points,respectively.Mean age of frail patients was 79.0(SD ± 7.8)years(P < 0.001)and median BMI of frail group was 23.4(IQR: 20.0-25.8)kg/m2(P < 0.001).Median education of frail group was 4(IQR: 0-9)years(P = 0.004)and 100 patients(90.1%)of frail group were ASA Grade ? or ?(P < 0.001).Median MMSE for frail patients was 15(IQR: 12-19)points(P < 0.001)and median Charlson Comorbidity Index for frail patients was 2(IQR: 1-3)points(P < 0.001).Median BADL of frail patients was 9(IQR: 5-11)points(P < 0.001)and median IADL of frail patients was 16(IQR: 12-20)points(P < 0.001).Median Alb in frail group was 35.0(IQR: 32.8-37.3)g/L(P < 0.001),and median IL-6 in frail group was 20.27(IQR: 10.74-30.04)ng/L(P < 0.001).Intraoperatively,median amount of blood loss was noted to be significantly higher in frail group(P < 0.001).Postoperatively,median hospital stay for frail group was 8(IQR: 7-11)days and 7(IQR: 6-8)days for non-frail group(P < 0.001).Moreover,the rate of readmission in frail group was significantly higher than that in non-frail group(frail patients: 13.0%,non-frail patients: 4.8%,P = 0.009).There was a statistically significant association between frailty and higher CCI.That is,mean 30-d CCI of frail patients was 31.0(SD ± 19.7)points and mean 30-d CCI of non-frail patients was 6.9(SD ± 11.7)points(P < 0.001).Besides we found the mean 30-d CCI increased with the increases of EFS in general.Ten(EFS,Age,BMI,ASA Grade,MMSE,Charlson Comorbidity Index,BADL,IADL,Alb,IL-6)of the initial 12 variables(EFS,Age,Sex,BMI,Education,ASA Grade,MMSE,Charlson Comorbidity Index,BADL,IADL,Alb,IL-6)for the adjusted analysis were joined into the multivariable model.There was a significant association between CCI and EFS(? = 2.4;95% CI: 1.101-3.645;P < 0.001)in a regression analysis,independent of confounding factors.In addition,we found ASA grade(? = 6.0;95 % CI: 1.176-10.820;P = 0.015)was also a risk factor for higher CCI.However,other variables did not reach statistical significance.Conclusions Frailty identified by EFS is significantly associated with increased CCI in elderly patients undergoing elective orthopedic surgery.