TY - JOUR
T1 - Comparison of Frailty Measures as Predictors of Outcomes After Orthopedic Surgery
AU - Cooper, Zara
AU - Rogers, Selwyn O.
AU - Ngo, Long
AU - Guess, Jamey
AU - Schmitt, Eva
AU - Jones, Richard N.
AU - Ayres, Douglas K.
AU - Walston, Jeremy D.
AU - Gill, Thomas M.
AU - Gleason, Lauren J.
AU - Inouye, Sharon K.
AU - Marcantonio, Edward R.
N1 - Funding Information:
The authors thank the participants, families, nurses, physicians, and study staff who participated in SAGES, Cyrus Kosar for his assistance with data preparation, and Dr. James Rudolph for his assistance with integrating the frailty measures into the SAGES cohort. This study was supported by Program Project Grant P01AG031720 to Dr. Inouye from the National Institute on Aging (NIA). Dr. Inouye's contribution was partially supported by Geriatric Leadership Award to Enhance Clinical Education and Training K07 AG041835 and R01AG044518; Dr. Marcantonio's contribution was partially supported by Mid-Career Investigator Award K24AG035075 and R01 AG030618, and Dr. Cooper's contribution was partially supported by GEMSSTAR R03AG042361, all from NIA. Dr. Cooper was also supported by a Jahnigen Award from the American Geriatrics Society. Dr. Walston is supported by the Johns Hopkins Older Americans Independence Center, National Institutes of Health (NIH) P30AG021334. Dr. Gill is the recipient of Academic Leadership Award K07AG043587 from the NIA. Dr. Gleason is supported by Health Resources and Services Administration Training Grant D01HP08794 and a John A. Hartford Foundation Center of Excellence Award. This work was conducted with support from Harvard Catalyst, The Harvard Clinical and Translational Science Center (National Center for Research Resources and National Center for Advancing Translational Sciences, NIH Award 8UL1TR000170–05, and financial contributions from Harvard University and its affiliated academic health care centers). The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, or NIH. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: All authors contributed to study concept and design, data analysis and interpretation, and preparation of manuscript. Sponsor's Role: None.
Publisher Copyright:
© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Objectives: To apply the Frailty Phenotype (FP) and Frailty Index (FI) before major elective orthopedic surgery to categorize frailty status and assess associations with postoperative outcomes. Design: Prospective cohort study. Setting: Two tertiary hospitals in Boston, Massachusetts. Participants: Individuals aged 70 and older undergoing scheduled orthopedic surgery enrolled in the Successful Aging after Elective Surgery (SAGES) Study (N = 415). Measurements: Preoperative evaluation included assessment of frailty using the FP and FI. The weighted kappa statistic was used to determine concordance between the two frailty measures and multivariable modeling to determine associations between each measure and postoperative complications, postoperative length of stay (LOS) of longer than 5 days, discharge to postacute institutional care (PAC), and 300 day readmission. Results: Frailty was highly prevalent (FP, 35%; FI, 41%). There was moderate concordance between the FP and FI (κ = 0.42, 95% confidence interval (CI) 0.36–0.49). When using the FP, being prefrail predicted greater risk of complications (relative risk (RR) = 1.6, 95% CI = 1.1–2.1) and discharge to PAC (RR = 1.8, 95% CI = 1.2–2.9) than being robust, and being frail predicted more complications (RR = 1.7, 95% CI = 1.1–2.1), LOS longer than 5 days (RR = 3.1, 95% CI = 1.1–8.8), and discharge to PAC (RR = 2.3 95% CI = 1.4–3.7). When using FI, being prefrail predicted LOS longer than 5 days (RR = 2.1, 95% CI = 1.0–4.8) and discharge to PAC (RR = 1.5, 95% CI = 1.4–2.1), as did being frail (RR = 1.9, 95% CI = 1.4–2.5; RR = 3.1, 95% CI = 1.4–6.8, respectively). The other outcomes were not significantly associated with frailty status. Conclusion: FP and FI predict postoperative outcomes after major elective orthopedic surgery and should be considered for preoperative risk stratification.
AB - Objectives: To apply the Frailty Phenotype (FP) and Frailty Index (FI) before major elective orthopedic surgery to categorize frailty status and assess associations with postoperative outcomes. Design: Prospective cohort study. Setting: Two tertiary hospitals in Boston, Massachusetts. Participants: Individuals aged 70 and older undergoing scheduled orthopedic surgery enrolled in the Successful Aging after Elective Surgery (SAGES) Study (N = 415). Measurements: Preoperative evaluation included assessment of frailty using the FP and FI. The weighted kappa statistic was used to determine concordance between the two frailty measures and multivariable modeling to determine associations between each measure and postoperative complications, postoperative length of stay (LOS) of longer than 5 days, discharge to postacute institutional care (PAC), and 300 day readmission. Results: Frailty was highly prevalent (FP, 35%; FI, 41%). There was moderate concordance between the FP and FI (κ = 0.42, 95% confidence interval (CI) 0.36–0.49). When using the FP, being prefrail predicted greater risk of complications (relative risk (RR) = 1.6, 95% CI = 1.1–2.1) and discharge to PAC (RR = 1.8, 95% CI = 1.2–2.9) than being robust, and being frail predicted more complications (RR = 1.7, 95% CI = 1.1–2.1), LOS longer than 5 days (RR = 3.1, 95% CI = 1.1–8.8), and discharge to PAC (RR = 2.3 95% CI = 1.4–3.7). When using FI, being prefrail predicted LOS longer than 5 days (RR = 2.1, 95% CI = 1.0–4.8) and discharge to PAC (RR = 1.5, 95% CI = 1.4–2.1), as did being frail (RR = 1.9, 95% CI = 1.4–2.5; RR = 3.1, 95% CI = 1.4–6.8, respectively). The other outcomes were not significantly associated with frailty status. Conclusion: FP and FI predict postoperative outcomes after major elective orthopedic surgery and should be considered for preoperative risk stratification.
KW - elderly
KW - frailty measures
KW - orthopedic procedures
KW - preoperative evaluation
KW - surgery outcomes
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U2 - 10.1111/jgs.14387
DO - 10.1111/jgs.14387
M3 - Article
C2 - 27801939
AN - SCOPUS:84996490794
SN - 0002-8614
VL - 64
SP - 2464
EP - 2471
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 12
ER -