Silvestre Jason, Bennett Zachary T, Moore John W, Guareschi Alexander S, Rogalski Brandon L, Eichinger Josef K, Friedman Richard J
Medical University of South Carolina, Charleston, SC, USA.
Medical University of South Carolina, Charleston, SC, USA.
J Shoulder Elbow Surg. 2025 Jul;34(7):1819-1825. doi: 10.1016/j.jse.2024.10.004. Epub 2024 Dec 3.
Frailty is an age-related state of multisystem decline that has been associated with negative outcomes after surgery. Numerous methods have been utilized to quantify frailty and predict postoperative outcomes with variable results. The purpose of this study is to determine if the Hospital Frailty Risk Score (HFRS) is an independent predictor of postoperative complications and increased healthcare costs following elective primary total shoulder arthroplasty (TSA).
The Nationwide Readmissions Database was queried to select patients undergoing elective primary TSA from 2016 to 2020. HFRS was calculated for each patient and patients with scores of 5 or greater were considered frail. Demographic characteristics, preoperative comorbidities, postoperative complications, and healthcare resource utilization metrics were compared between frail and nonfrail patients using bivariate analysis. Binary logistic regression was used to determine if HFRS was independently predictive of adverse postoperative outcomes.
There were 44,118 frail patients and 210,032 control patients undergoing TSA included in this study. After logistic regression analysis, HFRS was shown to be independently predictive of any complication (P < .001), readmission (P < .001), and mortality (P < .001) within 180 days of elective primary TSA. HFRS was predictive of periprosthetic fracture (P < .001), acute respiratory distress syndrome (P < .001), acute renal failure (P < .001), cellulitis (P < .001), pneumonia (P < .001), sepsis (P < .001), transfusion (P < .001), and urinary tract infection (P < .001). Frail patients had higher resource utilization than control patients, including a higher mean total cost of hospitalization ($20,991 vs. $18,869; P < .001) and a longer mean hospital LOS (3.1 vs. 1.4 days; P < .001). Frail patients were more likely to be discharged to a facility (P < .001) or with home healthcare (P < .001).
Frailty is independently associated with increased postoperative complications and healthcare utilization after elective primary TSA, and this study demonstrates the utility of HFRS as an adjunct for preoperative risk stratification and patient optimization prior to elective primary TSA. Frail patients had higher postoperative complications and healthcare costs after primary elective TSA compared to nonfrail patients. The HFRS is easily calculated from routinely collected patient data and thus can help orthopedic surgeons and healthcare systems identify high-risk patients without significant burden to current provider workflows.
衰弱是一种与年龄相关的多系统衰退状态，与手术后的不良后果相关。已经采用了多种方法来量化衰弱并预测术后结果，但结果各异。本研究的目的是确定医院衰弱风险评分（HFRS）是否是择期初次全肩关节置换术（TSA）后术后并发症和医疗费用增加的独立预测因素。
查询全国再入院数据库，以选择2016年至2020年接受择期初次TSA的患者。计算每位患者的HFRS，得分5分或更高的患者被视为衰弱。使用双变量分析比较衰弱和非衰弱患者的人口统计学特征、术前合并症、术后并发症和医疗资源利用指标。采用二元逻辑回归确定HFRS是否能独立预测术后不良结局。
本研究纳入了44,118例接受TSA的衰弱患者和210,032例对照患者。经过逻辑回归分析，结果显示HFRS可独立预测择期初次TSA后180天内的任何并发症（P <.001）、再入院（P <.001）和死亡率（P <.001）。HFRS可预测假体周围骨折（P <.001）、急性呼吸窘迫综合征（P <.001）、急性肾衰竭（P <.001）、蜂窝织炎（P <.001）、肺炎（P <.001）、败血症（P <.001）、输血（P <.001）和尿路感染（P <.001）。衰弱患者的资源利用率高于对照患者，包括更高的平均住院总费用（20,991美元对18,869美元；P <.001）和更长的平均住院时间（3.1天对1.4天；P <.001）。衰弱患者更有可能被转至医疗机构（P <.001）或接受家庭医疗护理（P <.001）。
衰弱与择期初次TSA术后并发症增加和医疗利用增加独立相关，本研究证明了HFRS作为择期初次TSA术前风险分层和患者优化辅助工具的实用性。与非衰弱患者相比，衰弱患者在初次择期TSA术后有更高的术后并发症和医疗费用。HFRS可根据常规收集的患者数据轻松计算得出，因此可以帮助骨科医生和医疗系统识别高危患者，而不会给当前的医疗工作流程带来重大负担。
