Johnson Rebecca L, Abdel Matthew P, Frank Ryan D, Chamberlain Alanna M, Habermann Elizabeth B, Mantilla Carlos B
Orthopedics. 2019 Nov 1;42(6):335-343. doi: 10.3928/01477447-20190812-05. Epub 2019 Aug 14.
This cohort study of adult (≥50 years) patients aimed to calculate a validated, preoperative frailty deficit index (FI) and used it to compare outcomes following total knee arthroplasty (TKA), primary and revision, from 2005 through 2016. Using multivariable logistic and Cox regression, the authors analyzed whether FI, adjusted for age, predicts outcomes prior to hospital discharge, within 90 days, and within 365 days. They classified 9818 patients undergoing TKA (7920 primary and 1898 revision; median age, 69 years) as frail (21%), vulnerable (39%), and non-frail (40%). Frail, relative to non-frail, patients were more often female with more systemic diseases (American Society of Anesthesiologists classification, ≥III). While in-hospital, frail patients were found to have increased odds of reoperation (odds ratio, 2.52) and wound complications/hematoma (odds ratio, 2.15). Within 90 days, there was increased risk for periprosthetic fracture (>4-fold) and mortality (>9-fold) following TKA after age adjustment. Within the first year, frail patients were at heightened risk for death (hazard ratio, 8.08), any patient infection (hazard ratio, 1.97), wound complications/hematoma (hazard ratio, 2.16), periprosthetic fracture (hazard ratio, 3.03), and reoperation (hazard ratio, 1.41). At no time point were significant associations found with arthrofibrosis, aseptic loosening, or patellar clunk syndrome. One-fifth of patients undergoing primary and revision TKAs are frail and at notable risk for complications. Calculating a preoperative FI should guide pre-habilitation efforts (eg, chronic disease management, wellness) before and postoperative surveillance after TKA. [Orthopedics. 2019; 42(6):335-343.].
这项针对成年（≥50岁）患者的队列研究旨在计算经过验证的术前衰弱缺陷指数（FI），并使用该指数比较2005年至2016年全膝关节置换术（TKA）（初次和翻修）后的结局。作者使用多变量逻辑回归和Cox回归分析了经年龄调整后的FI是否能预测出院前、90天内和365天内的结局。他们将9818例行TKA的患者（7920例初次手术和1898例翻修手术；中位年龄69岁）分为衰弱（21%）、脆弱（39%）和非衰弱（40%）三类。与非衰弱患者相比，衰弱患者女性更多，患有更多的全身性疾病（美国麻醉医师协会分级，≥III级）。住院期间，衰弱患者再次手术的几率（优势比，2.52）和伤口并发症/血肿的几率（优势比，2.15）增加。年龄调整后，TKA术后90天内，假体周围骨折（>4倍）和死亡率（>9倍）风险增加。在第一年，衰弱患者死亡风险（风险比，8.08）、任何患者感染风险（风险比，1.97）、伤口并发症/血肿风险（风险比，2.16）、假体周围骨折风险（风险比，3.03）和再次手术风险（风险比，1.41）均升高。在任何时间点均未发现与关节纤维化、无菌性松动或髌骨撞击综合征存在显著关联。接受初次和翻修TKA手术的患者中有五分之一衰弱，且并发症风险显著。计算术前FI应指导TKA术前的预康复措施（如慢性病管理、健康促进）及术后监测。[《骨科》。2019；42(6):335 - 343。]
