Comparison of Frailty Measures as Predictors of Outcomes After Orthopedic Surgery

Zara Cooper, Selwyn O. Rogers, Long Ngo, Jamey Guess, Eva Schmitt, Richard N. Jones, Douglas K. Ayres, Jeremy D. Walston, Thomas M. Gill, Lauren J. Gleason, Sharon K. Inouye, Edward R. Marcantonio

    Research output: Contribution to journalArticle

    16 Citations (Scopus)

    Abstract

    Objectives: To apply the Frailty Phenotype (FP) and Frailty Index (FI) before major elective orthopedic surgery to categorize frailty status and assess associations with postoperative outcomes. Design: Prospective cohort study. Setting: Two tertiary hospitals in Boston, Massachusetts. Participants: Individuals aged 70 and older undergoing scheduled orthopedic surgery enrolled in the Successful Aging after Elective Surgery (SAGES) Study (N = 415). Measurements: Preoperative evaluation included assessment of frailty using the FP and FI. The weighted kappa statistic was used to determine concordance between the two frailty measures and multivariable modeling to determine associations between each measure and postoperative complications, postoperative length of stay (LOS) of longer than 5 days, discharge to postacute institutional care (PAC), and 300 day readmission. Results: Frailty was highly prevalent (FP, 35%; FI, 41%). There was moderate concordance between the FP and FI (κ = 0.42, 95% confidence interval (CI) 0.36–0.49). When using the FP, being prefrail predicted greater risk of complications (relative risk (RR) = 1.6, 95% CI = 1.1–2.1) and discharge to PAC (RR = 1.8, 95% CI = 1.2–2.9) than being robust, and being frail predicted more complications (RR = 1.7, 95% CI = 1.1–2.1), LOS longer than 5 days (RR = 3.1, 95% CI = 1.1–8.8), and discharge to PAC (RR = 2.3 95% CI = 1.4–3.7). When using FI, being prefrail predicted LOS longer than 5 days (RR = 2.1, 95% CI = 1.0–4.8) and discharge to PAC (RR = 1.5, 95% CI = 1.4–2.1), as did being frail (RR = 1.9, 95% CI = 1.4–2.5; RR = 3.1, 95% CI = 1.4–6.8, respectively). The other outcomes were not significantly associated with frailty status. Conclusion: FP and FI predict postoperative outcomes after major elective orthopedic surgery and should be considered for preoperative risk stratification.

    Original languageEnglish (US)
    Pages (from-to)2464-2471
    Number of pages8
    JournalJournal of the American Geriatrics Society
    Volume64
    Issue number12
    DOIs
    StatePublished - Dec 1 2016

    Fingerprint

    Orthopedics
    Confidence Intervals
    Subacute Care
    Phenotype
    Length of Stay
    Tertiary Care Centers
    Cohort Studies
    Prospective Studies

    Keywords

    • elderly
    • frailty measures
    • orthopedic procedures
    • preoperative evaluation
    • surgery outcomes

    ASJC Scopus subject areas

    • Geriatrics and Gerontology

    Cite this

    Cooper, Z., Rogers, S. O., Ngo, L., Guess, J., Schmitt, E., Jones, R. N., ... Marcantonio, E. R. (2016). Comparison of Frailty Measures as Predictors of Outcomes After Orthopedic Surgery. Journal of the American Geriatrics Society, 64(12), 2464-2471. https://doi.org/10.1111/jgs.14387

    Comparison of Frailty Measures as Predictors of Outcomes After Orthopedic Surgery. / Cooper, Zara; Rogers, Selwyn O.; Ngo, Long; Guess, Jamey; Schmitt, Eva; Jones, Richard N.; Ayres, Douglas K.; Walston, Jeremy D.; Gill, Thomas M.; Gleason, Lauren J.; Inouye, Sharon K.; Marcantonio, Edward R.

    In: Journal of the American Geriatrics Society, Vol. 64, No. 12, 01.12.2016, p. 2464-2471.

    Research output: Contribution to journalArticle

    Cooper, Z, Rogers, SO, Ngo, L, Guess, J, Schmitt, E, Jones, RN, Ayres, DK, Walston, JD, Gill, TM, Gleason, LJ, Inouye, SK & Marcantonio, ER 2016, 'Comparison of Frailty Measures as Predictors of Outcomes After Orthopedic Surgery', Journal of the American Geriatrics Society, vol. 64, no. 12, pp. 2464-2471. https://doi.org/10.1111/jgs.14387
    Cooper, Zara ; Rogers, Selwyn O. ; Ngo, Long ; Guess, Jamey ; Schmitt, Eva ; Jones, Richard N. ; Ayres, Douglas K. ; Walston, Jeremy D. ; Gill, Thomas M. ; Gleason, Lauren J. ; Inouye, Sharon K. ; Marcantonio, Edward R. / Comparison of Frailty Measures as Predictors of Outcomes After Orthopedic Surgery. In: Journal of the American Geriatrics Society. 2016 ; Vol. 64, No. 12. pp. 2464-2471.
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    abstract = "Objectives: To apply the Frailty Phenotype (FP) and Frailty Index (FI) before major elective orthopedic surgery to categorize frailty status and assess associations with postoperative outcomes. Design: Prospective cohort study. Setting: Two tertiary hospitals in Boston, Massachusetts. Participants: Individuals aged 70 and older undergoing scheduled orthopedic surgery enrolled in the Successful Aging after Elective Surgery (SAGES) Study (N = 415). Measurements: Preoperative evaluation included assessment of frailty using the FP and FI. The weighted kappa statistic was used to determine concordance between the two frailty measures and multivariable modeling to determine associations between each measure and postoperative complications, postoperative length of stay (LOS) of longer than 5 days, discharge to postacute institutional care (PAC), and 300 day readmission. Results: Frailty was highly prevalent (FP, 35{\%}; FI, 41{\%}). There was moderate concordance between the FP and FI (κ = 0.42, 95{\%} confidence interval (CI) 0.36–0.49). When using the FP, being prefrail predicted greater risk of complications (relative risk (RR) = 1.6, 95{\%} CI = 1.1–2.1) and discharge to PAC (RR = 1.8, 95{\%} CI = 1.2–2.9) than being robust, and being frail predicted more complications (RR = 1.7, 95{\%} CI = 1.1–2.1), LOS longer than 5 days (RR = 3.1, 95{\%} CI = 1.1–8.8), and discharge to PAC (RR = 2.3 95{\%} CI = 1.4–3.7). When using FI, being prefrail predicted LOS longer than 5 days (RR = 2.1, 95{\%} CI = 1.0–4.8) and discharge to PAC (RR = 1.5, 95{\%} CI = 1.4–2.1), as did being frail (RR = 1.9, 95{\%} CI = 1.4–2.5; RR = 3.1, 95{\%} CI = 1.4–6.8, respectively). The other outcomes were not significantly associated with frailty status. Conclusion: FP and FI predict postoperative outcomes after major elective orthopedic surgery and should be considered for preoperative risk stratification.",
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    author = "Zara Cooper and Rogers, {Selwyn O.} and Long Ngo and Jamey Guess and Eva Schmitt and Jones, {Richard N.} and Ayres, {Douglas K.} and Walston, {Jeremy D.} and Gill, {Thomas M.} and Gleason, {Lauren J.} and Inouye, {Sharon K.} and Marcantonio, {Edward R.}",
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    T1 - Comparison of Frailty Measures as Predictors of Outcomes After Orthopedic Surgery

    AU - Cooper, Zara

    AU - Rogers, Selwyn O.

    AU - Ngo, Long

    AU - Guess, Jamey

    AU - Schmitt, Eva

    AU - Jones, Richard N.

    AU - Ayres, Douglas K.

    AU - Walston, Jeremy D.

    AU - Gill, Thomas M.

    AU - Gleason, Lauren J.

    AU - Inouye, Sharon K.

    AU - Marcantonio, Edward R.

    PY - 2016/12/1

    Y1 - 2016/12/1

    N2 - Objectives: To apply the Frailty Phenotype (FP) and Frailty Index (FI) before major elective orthopedic surgery to categorize frailty status and assess associations with postoperative outcomes. Design: Prospective cohort study. Setting: Two tertiary hospitals in Boston, Massachusetts. Participants: Individuals aged 70 and older undergoing scheduled orthopedic surgery enrolled in the Successful Aging after Elective Surgery (SAGES) Study (N = 415). Measurements: Preoperative evaluation included assessment of frailty using the FP and FI. The weighted kappa statistic was used to determine concordance between the two frailty measures and multivariable modeling to determine associations between each measure and postoperative complications, postoperative length of stay (LOS) of longer than 5 days, discharge to postacute institutional care (PAC), and 300 day readmission. Results: Frailty was highly prevalent (FP, 35%; FI, 41%). There was moderate concordance between the FP and FI (κ = 0.42, 95% confidence interval (CI) 0.36–0.49). When using the FP, being prefrail predicted greater risk of complications (relative risk (RR) = 1.6, 95% CI = 1.1–2.1) and discharge to PAC (RR = 1.8, 95% CI = 1.2–2.9) than being robust, and being frail predicted more complications (RR = 1.7, 95% CI = 1.1–2.1), LOS longer than 5 days (RR = 3.1, 95% CI = 1.1–8.8), and discharge to PAC (RR = 2.3 95% CI = 1.4–3.7). When using FI, being prefrail predicted LOS longer than 5 days (RR = 2.1, 95% CI = 1.0–4.8) and discharge to PAC (RR = 1.5, 95% CI = 1.4–2.1), as did being frail (RR = 1.9, 95% CI = 1.4–2.5; RR = 3.1, 95% CI = 1.4–6.8, respectively). The other outcomes were not significantly associated with frailty status. Conclusion: FP and FI predict postoperative outcomes after major elective orthopedic surgery and should be considered for preoperative risk stratification.

    AB - Objectives: To apply the Frailty Phenotype (FP) and Frailty Index (FI) before major elective orthopedic surgery to categorize frailty status and assess associations with postoperative outcomes. Design: Prospective cohort study. Setting: Two tertiary hospitals in Boston, Massachusetts. Participants: Individuals aged 70 and older undergoing scheduled orthopedic surgery enrolled in the Successful Aging after Elective Surgery (SAGES) Study (N = 415). Measurements: Preoperative evaluation included assessment of frailty using the FP and FI. The weighted kappa statistic was used to determine concordance between the two frailty measures and multivariable modeling to determine associations between each measure and postoperative complications, postoperative length of stay (LOS) of longer than 5 days, discharge to postacute institutional care (PAC), and 300 day readmission. Results: Frailty was highly prevalent (FP, 35%; FI, 41%). There was moderate concordance between the FP and FI (κ = 0.42, 95% confidence interval (CI) 0.36–0.49). When using the FP, being prefrail predicted greater risk of complications (relative risk (RR) = 1.6, 95% CI = 1.1–2.1) and discharge to PAC (RR = 1.8, 95% CI = 1.2–2.9) than being robust, and being frail predicted more complications (RR = 1.7, 95% CI = 1.1–2.1), LOS longer than 5 days (RR = 3.1, 95% CI = 1.1–8.8), and discharge to PAC (RR = 2.3 95% CI = 1.4–3.7). When using FI, being prefrail predicted LOS longer than 5 days (RR = 2.1, 95% CI = 1.0–4.8) and discharge to PAC (RR = 1.5, 95% CI = 1.4–2.1), as did being frail (RR = 1.9, 95% CI = 1.4–2.5; RR = 3.1, 95% CI = 1.4–6.8, respectively). The other outcomes were not significantly associated with frailty status. Conclusion: FP and FI predict postoperative outcomes after major elective orthopedic surgery and should be considered for preoperative risk stratification.

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    KW - frailty measures

    KW - orthopedic procedures

    KW - preoperative evaluation

    KW - surgery outcomes

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