From the Duke Department of Orthopedic Trauma Surgery, University Health System, Durham, NC (Dr. Pean and Dr. DeBaun); the Harvard Orthopedic Trauma Initiative, Brigham and Women's Hospital/Massachusetts General Hospital, Boston, MA (Thomas, Dr. Weaver, and Dr. von Keudell); the Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (Dr. Singh and Dr. von Keudell), and Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark (Dr. von Keudell).
J Am Acad Orthop Surg Glob Res Rev. 2023 Jan 19;7(1). doi: 10.5435/JAAOSGlobal-D-22-00286. eCollection 2023 Jan 1.
This is a retrospective study evaluating the use of a new six-item modified frailty index (MF-6) to predict short-term outcomes of patients receiving surgery for lower extremity fractures.
Patients older than 65 years undergoing open reduction and internal fixation for lower extremity, pelvic, and acetabulum fractures were identified from the American College of Surgeons National Surgical Quality Improvement Program. The MF-6 was calculated by assigning one point for each of six common conditions. Multivariable analysis was used to compare patients with an MF-6 of <3 and ≥3. Outcome measures included complications, mortality, readmission, revision surgery, and length of stay. An area under the curve receiver operator analysis was conducted to compare the MF-6 with MF-5, an existing five-item frailty index.
Nine thousand four hundred sixty-three patients were included. Patients with an MF-6 of ≥3 were at markedly higher risk of discharge destination other than home (Exp[B] = 2.09), mortality (Exp[B] = 2.48), major adverse events (Exp[B] = 2.16), and readmission (Exp[B] = 1.82). Receiver-operating curve analysis demonstrated an area under the curve of 0.65 for mortality, 0.62 for major adverse events, and 0.62 for discharge destination other than home, all of which outperformed the MF-5.
The MF-6 was correlated with a 30-day postoperative incidence of infectious complications, readmission, and discharge destination. MF-6 scores can be used to risk-stratify patient populations as shifts to value-based care continue to develop.
这是一项回顾性研究，评估了新的六项修正虚弱指数（MF-6）在预测下肢骨折患者接受手术治疗的短期结局中的应用。
从美国外科医师学会国家手术质量改进计划中确定了 65 岁以上接受下肢、骨盆和髋臼骨折切开复位内固定术的患者。通过为六项常见疾病中的每一项分配一分来计算 MF-6。多变量分析用于比较 MF-6<3 和≥3 的患者。结局指标包括并发症、死亡率、再入院、翻修手术和住院时间。进行曲线下面积接收器操作分析，比较 MF-6 与现有的五项虚弱指数（MF-5）。
共纳入 9463 例患者。MF-6≥3 的患者出院后去其他地方（Exp[B] = 2.09）、死亡（Exp[B] = 2.48）、主要不良事件（Exp[B] = 2.16）和再入院（Exp[B] = 1.82）的风险显著更高。受试者工作特征曲线分析显示，死亡率的曲线下面积为 0.65，主要不良事件的曲线下面积为 0.62，出院去其他地方的曲线下面积为 0.62，均优于 MF-5。
MF-6 与术后 30 天内感染性并发症、再入院和出院去向有关。随着基于价值的护理的持续发展，MF-6 评分可用于对患者人群进行风险分层。
