Congiusta Dominick, Amer Kamil, Pooja Suri Dr, Merchant Aziz M, Ahmed Irfan H, Vosbikian Michael M
Department of Orthopaedic Surgery, Rutgers University, New Jersey Medical School, 140 Bergen Street, D-1610, Newark, NJ, 07103, USA.
Rutgers New Jersey Medical School, USA.
J Clin Orthop Trauma. 2020 Jul 18;14:121-126. doi: 10.1016/j.jcot.2020.07.014. eCollection 2021 Mar.
Frailty is a well-known predictor of adverse postoperative outcomes and is often considered in the preoperative planning stage of surgery. In recent years, the modified frailty index (mFI), a novel metric used to quantify frailty, has become increasingly used in the orthopedic literature as a risk assessment tool. In this study, we analyze the utility of the mFI in predicting unplanned repeat operations and morbidity in the surgical treatment forearm fractures.
We used the American College of Surgeons National Surgical Quality Improvement Program 2006-2014 dataset to identify patients undergoing open fixation of forearm fractures. The mFI was calculated based on 5 possible comorbid conditions. Demographic and predictor variables were analyzed for associations with each outcome. In order to assess frailty in both the general and elderly population, two analyses were completed: one for the entire population and one for a population of age 65 or older. The primary outcome of interest was unplanned repeat operation. Secondary outcomes included discharge destination and major post-operative complications. Chi square and logistic regression analyses were used to identify associations.
A total of 4641 patients were included in our final analysis. There was a higher prevalence of females and patients between the ages of 61 and 80 compared to other age groups. An mFI score ≥2 was a positively associated with unplanned repeat operation in the general population. An mFI score ≥2 was also positively associated with a discharge destination other than home and major post-operative complications. In the elderly population, mFI ≥2 was similarly associated with a discharge destination other than the patient's home.
Patients undergoing open treatment of forearm fractures were at an increased likelihood of having an unplanned repeat operation and having major complications as frailty score increased, demonstrating that the mFI may be clinically applicable risk assessment tool for these patients.
衰弱是术后不良结局的一个众所周知的预测指标，并且在手术的术前规划阶段经常被考虑。近年来，改良衰弱指数（mFI）作为一种用于量化衰弱的新指标，在骨科文献中越来越多地被用作风险评估工具。在本研究中，我们分析了mFI在预测手术治疗前臂骨折的非计划再次手术和发病率方面的效用。
我们使用美国外科医师学会国家外科质量改进计划2006 - 2014年数据集来识别接受前臂骨折切开内固定术的患者。mFI基于5种可能的合并症进行计算。分析人口统计学和预测变量与每个结局的关联。为了评估一般人群和老年人群中的衰弱情况，完成了两项分析：一项针对全体人群，另一项针对65岁及以上人群。感兴趣的主要结局是非计划再次手术。次要结局包括出院目的地和主要术后并发症。使用卡方检验和逻辑回归分析来确定关联。
我们的最终分析共纳入4641例患者。与其他年龄组相比，女性以及61至80岁患者的患病率更高。在一般人群中，mFI评分≥2与非计划再次手术呈正相关。mFI评分≥2也与出院目的地不是回家以及主要术后并发症呈正相关。在老年人群中，mFI≥2同样与出院目的地不是患者家中呈正相关。
接受前臂骨折切开治疗的患者随着衰弱评分增加，发生非计划再次手术和出现主要并发症的可能性增加，这表明mFI可能是适用于这些患者的临床风险评估工具。
