Department of Orthopaedics, Medical University of South Carolina, Charleston, SC.
J Arthroplasty. 2019 Jul;34(7):1412-1416. doi: 10.1016/j.arth.2019.02.060. Epub 2019 Mar 7.
The purpose of this study is to evaluate the 5-factor modified frailty index (mFI-5) as a predictor of postoperative complications, readmission, and mortality in patients undergoing revision hip and knee arthroplasty.
A retrospective analysis of the American College of Surgeon's National Surgical Quality Improvement Program's database for patients undergoing revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) between the years 2005 and 2016 was conducted. The 5-factor score, which includes presence of comorbid diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functional status, was calculated for each patient. Multivariate logistic regression models were used to assess the relationship between the mFI-5 and postoperative complications while controlling for demographic variables.
In total, 13,948 patients undergoing rTHA and 16,304 patients undergoing rTKA were identified. The mFI-5 was a strong predictor of serious medical complications (cardiac arrest, myocardial infarction, septic shock, pulmonary embolism, postoperative dialysis, reintubation, and prolonged ventilator requirement), discharge to a facility, total length of stay, readmission, and mortality (P ≤ .007).
The mFI-5 predicts serious medical complications, increased length of stay, discharge to a facility, hospital readmission, and mortality in patients undergoing rTHA and rTKA. All the variables within the mFI-5 are easily obtained through the patient history, allowing for a practical clinical tool that hospitals and physicians can use to identify at-risk patients, educate and engage patients and their families in a shared decision-making conversation, and guide perioperative care in order to optimize patient outcomes.
III.
本研究旨在评估五因素改良衰弱指数（mFI-5）在预测髋关节和膝关节翻修术后并发症、再入院和死亡率方面的作用。
对美国外科医师学会国家手术质量改进计划数据库中 2005 年至 2016 年间接受髋关节翻修术（rTHA）和膝关节翻修术（rTKA）的患者进行回顾性分析。为每位患者计算了包括合并症糖尿病、高血压、充血性心力衰竭、慢性阻塞性肺疾病和功能状态在内的五因素评分。使用多变量逻辑回归模型评估 mFI-5 与术后并发症之间的关系，同时控制人口统计学变量。
共确定了 13948 例 rTHA 和 16304 例 rTKA 患者。mFI-5 是严重医疗并发症（心搏骤停、心肌梗死、感染性休克、肺栓塞、术后透析、再插管和延长呼吸机需求）、出院至医疗机构、总住院时间、再入院和死亡率的强预测因子（P ≤.007）。
mFI-5 可预测髋关节和膝关节翻修术患者的严重医疗并发症、住院时间延长、出院至医疗机构、医院再入院和死亡率。mFI-5 中的所有变量都可以通过病史轻松获得，这使其成为一种实用的临床工具，医院和医生可以使用该工具来识别高风险患者，教育和参与患者及其家属的共同决策对话，并指导围手术期护理，以优化患者结局。
III 级。
