Koltenyuk Victor, Merckling Matthew, Li Michael, Jarin Ian, Konigsberg Matthew
School of Medicine, New York Medical College, Valhalla, New York.
Department of Orthopaedic Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York.
J Wrist Surg. 2024 Jul 17;13(6):522-527. doi: 10.1055/s-0044-1788295. eCollection 2024 Dec.
The modified five-factor frailty index (mFI-5) is a better predictor than age alone of increased risk of extended length of stay (LOS) and postoperative complications in patients undergoing total wrist arthrodesis (TWA). The National Inpatient Sample database was queried for patients undergoing elective TWA. Patients were identified using the International Classification of Diseases, 10th Revision procedure codes, excluding nonelective cases, hardware removal, and patients with cerebral palsy or seizure disorders. Frailty was assessed by identifying the variables used in the mFI-5 and patients were categorized as nonfrail (mFI-5 = 0), prefrail (mFI-5 = 1), and frail (mFI-5 ≥ 2). Outcomes assessed included LOS and immediate postoperative complications such as nausea and vomiting requiring admission, acute kidney injury, postoperative hypotension, postoperative hypothyroidism, and urinary tract infection. Logistic regression was used to analyze the association between frailty status and both extended LOS and immediate postoperative complications. Between 2015 and 2019, 685 patients underwent TWA, with 49.6% not frail, 33.5% prefrail, and 16.7% frail. Prefrail and frail patients were at increased risk of undergoing extended LOS (OR 2.182, = 0.001; OR 2.312, = 0.002, respectively). Age over 65 (OR 1.995, < 0.001) and female sex (OR 1.605, = 0.029) were also independent risk factors. Frail patients were found to have an increased likelihood of acquiring any postoperative complication (OR 3.865, < 0.001), while elderly age was not a significant risk factor (OR 1.361, = 0.298). Using receiver operating characteristic (ROC) curve analysis, the mFI-5 demonstrated superior discriminatory ability compared with age for extended LOS (Area under the curve (AUC) 0.729 vs. 0.542) and postoperative complications (AUC 0.712 vs. 0.673). Our study demonstrates that both elderly age and frailty are independent predictors of extended hospitalization following TWA, while frailty but not age, is a significant predictor of immediate postoperative complications. To our knowledge, our study is the first to report an association between frailty status and immediate postoperative complications following TWA. Incorporating a preoperative frailty screening can allow for more open and informed preoperative discussion about surgical risk for elective procedures such as TWA, as well as allow for enhanced postoperative planning.
改良的五因素衰弱指数（mFI-5）比单纯年龄更能预测全腕关节融合术（TWA）患者住院时间延长（LOS）和术后并发症风险增加。
通过查询国家住院患者样本数据库来确定接受择期TWA的患者。使用国际疾病分类第十版手术编码来识别患者，排除非择期病例、内固定取出术以及患有脑瘫或癫痫疾病的患者。通过确定mFI-5中使用的变量来评估衰弱情况，患者被分为非衰弱（mFI-5 = 0）、衰弱前期（mFI-5 = 1）和衰弱（mFI-5≥2）。评估的结局包括住院时间和术后即刻并发症，如需要入院治疗的恶心和呕吐、急性肾损伤、术后低血压、术后甲状腺功能减退和尿路感染。使用逻辑回归分析衰弱状态与延长住院时间和术后即刻并发症之间的关联。
在2015年至2019年期间，685例患者接受了TWA，其中49.6%为非衰弱患者，33.5%为衰弱前期患者，16.7%为衰弱患者。衰弱前期和衰弱患者住院时间延长的风险增加（OR分别为2.182，P = 0.001；OR为2.312，P = 0.002）。65岁以上（OR为1.995，P < 0.001）和女性（OR为1.605，P = 0.029）也是独立的危险因素。发现衰弱患者发生任何术后并发症的可能性增加（OR为3.865，P < 0.001），而老年并非显著危险因素（OR为1.361，P = 0.298）。使用受试者工作特征（ROC）曲线分析，mFI-5在预测延长住院时间方面的辨别能力优于年龄（曲线下面积（AUC）分别为0.729和0.542），在预测术后并发症方面也是如此（AUC分别为0.712和0.673）。
我们的研究表明，老年和衰弱都是TWA后住院时间延长的独立预测因素，而衰弱而非年龄是术后即刻并发症的显著预测因素。据我们所知，我们的研究是首个报道TWA后衰弱状态与术后即刻并发症之间关联的研究。纳入术前衰弱筛查可以使针对TWA等择期手术的手术风险进行更开放和明智的术前讨论，同时也有助于加强术后规划。
