The impact of frailty on outcomes and healthcare resource usage after total joint arthroplasty

Author:

McIsaac D. I.1,Beaulé P. E.2,Bryson G. L.1,Van Walraven C.3

Affiliation:

1. The Ottawa Hospital, Civic Campus, Room B311, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada.

2. University of Ottawa, 501 Smyth Rd, CCW 1646, Ottawa ON, KiH 8L6, Canada.

3. University of Ottawa, 1st Floor Administrative Services Building, The Ottawa Hospital, 1053 Carling Ave, Ottawa ON, K1Y 4E9, Canada.

Abstract

Aims Total joint arthroplasty (TJA) is commonly performed in elderly patients. Frailty, an aggregate expression of vulnerability, becomes increasingly common with advanced age, and independently predicts adverse outcomes and the use of resources after a variety of non-cardiac surgical procedures. Our aim was to assess the impact of frailty on outcomes after TJA. Patients and Methods We analysed the impact of pre-operative frailty on death and the use of resources after elective TJA in a population-based cohort study using linked administrative data from Ontario, Canada. Results Of 125 163 patients aged > 65 years having elective TJA, 3023 (2.4%) were frail according to the Johns Hopkins ACG frailty-defining diagnoses indicator. One year follow-up was complete for all patients. Frail patients had a higher adjusted one year risk of mortality (hazard ratio 3.03, 95% confidence interval (CI) 2.62 to 3.51), a higher rate of admission to intensive care (odds ratio (OR) 2.52, 95% CI 2.21 to 2.89), increased length of stay (incidence rate ratio 1.62, 95% CI 1.59 to 1.65), a higher rate of discharge to institutional care (OR 2.09, 95% CI 1.93 to 2.25), a higher rate of re-admission (OR 1.33, 95% CI 1.07 to 1.66) and increased costs at 30, 90 and 365 days post-operatively. Frailty affected outcomes after total hip arthroplasty more than after total knee arthroplasty. Take home message: Frailty is an important risk factor for death after elective TJA, and increases post-operative resource utilisation across many metrics. Processes to optimise the outcomes and efficiency of TJA in frail patients are needed. Cite this article: Bone Joint J 2016;98-B:799–805.

Publisher

British Editorial Society of Bone & Joint Surgery

Subject

Orthopedics and Sports Medicine,Surgery

Reference50 articles.

1. No authors listed. CIHI. Hip and Knee Replacements in Canada : Canadian Joint Replacement Registry 2013 Annual Report. https://secure.cihi.ca/free_products/CJRR_2013_Annual_Report_EN.pdf (date last accessed 01 February 2016).

2. No authors listed. Sixty-five plus in the United States. US Census Bur Stat Br. 1995. Available at: http://www.census.gov/population/socdemo/statbriefs/agebrief.html (date last accessed 01 Febuary 2016).

3. No authors listed. Statistics Canada. The Canadian Population in 2011: Age and Sex. https://www12.statcan.gc.ca/census-recensement/2011/as-sa/98-311-x/98-311-x2011001-eng.cfm (date last accessed 01 February 2016).

4. Thirty-Day Postoperative Complications and Mortality Following Total Knee Arthroplasty

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