Seilern Und Aspang Jesse, Zamanzadeh Ryan S, Schwartz Andrew M, Premkumar Ajay, Martin J Ryan, Wilson Jacob M
Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia.
Department of Orthopaedics, Duke University, Durham, North Carolina.
J Arthroplasty. 2022 Jun;37(6):1098-1104. doi: 10.1016/j.arth.2022.02.055. Epub 2022 Feb 18.
Frailty and increasing age are well-established risk factors in patients undergoing total hip arthroplasty (THA). However, these variables have only been considered independently. This study assesses the interplay between age and frailty and introduces a novel age-adjusted modified frailty index (aamFI) for more refined risk stratification of THA patients.
The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2015 to 2019 for patients undergoing primary THA. First, outcomes were compared between chronologically younger and older frail patients. Then, to establish the aamFI, one additional point was added to the previously described mFI-5 for patients aged ≥73 years (the 75th percentile for age in our study population). The association of aamFI with postoperative complications and resource utilization was then analyzed categorically.
A total of 165,957 THA patients were evaluated. Older frail patients had a higher incidence of complications than younger frail patients. Regression analysis demonstrated a strong association between aamFI and complications. For instance, an aamFI of ≥3 (compared to aamFI of 0) was associated with an increased odds of mortality (OR: 22.01, 95% confidence interval [CI] 11.62-41.68), any complication (OR: 3.50, 95% CI 3.23-3.80), deep vein thrombosis (OR: 2.85, 95% CI 2.03-4.01), and nonhome discharge (OR 9.61, 95% CI 9.04-10.21; all P < .001).
Chronologically, older patients are impacted more by frailty than younger patients. The aamFI accounts for this and outperforms the mFI-5 in prediction of postoperative complications and resource utilization in patients undergoing primary THA.
衰弱和年龄增长是接受全髋关节置换术（THA）患者公认的危险因素。然而，这些变量仅被单独考虑。本研究评估年龄与衰弱之间的相互作用，并引入一种新的年龄调整改良衰弱指数（aamFI），以对THA患者进行更精细的风险分层。
查询2015年至2019年美国外科医师学会国家外科质量改进计划数据库中接受初次THA的患者。首先，比较按时间顺序排列的年轻和年老衰弱患者的结局。然后，为建立aamFI，对于年龄≥73岁（我们研究人群年龄的第75百分位数）的患者，在先前描述的mFI-5基础上增加1分。然后对aamFI与术后并发症和资源利用的关联进行分类分析。
共评估了165,957例THA患者。年老衰弱患者的并发症发生率高于年轻衰弱患者。回归分析表明aamFI与并发症之间存在密切关联。例如，aamFI≥3（与aamFI为0相比）与死亡率增加（比值比[OR]：22.01，95%置信区间[CI] 11.62 - 41.68）、任何并发症（OR：3.50，95% CI 3.23 - 3.80）、深静脉血栓形成（OR：2.85，95% CI 2.03 - 4.01）以及非家庭出院（OR 9.61，95% CI 9.04 - 10.21；所有P <.001）相关。
按时间顺序，年老患者比年轻患者更容易受到衰弱的影响。aamFI考虑到了这一点，并且在预测初次THA患者的术后并发症和资源利用方面优于mFI-5。
