Yoğun bakım ünitesine kabul edilen kalça ve diz artroplasti hastalarında Modifiye Frailty İndeksi'nin erken mortaliteyi öngörme değeri

Abstract

Amaçlar: Kalça ve diz artroplasti işlemlerinin sayısının artmasıyla birlikte, ameliyat sonrası komplikasyonlara yatkınlığı artırabilecek komorbid durumları olan hastaların sayısı da artmaktadır. Amaç, kalça veya diz artroplastisi sonrası 7 gün içinde yoğun bakım ünitesine (YBÜ) yatış endikasyonu gelişen hastalarda ameliyat sonrası erken mortalite ile ameliyat öncesi kırılganlık arasındaki ilişkiyi belirlemektir. Yöntemler: Bu çalışma, Ekim 2024 ile Ekim 2025 tarihleri arasında tek bir merkezde kalça ve diz artroplastisi geçiren ve ardından ilk hastane yatışları sırasında yoğun bakım ünitesine yatırılması gereken hastaları içeren retrospektif, gözlemsel bir çalışmadır. Modifiye Frailty Endeksi (mFI) tıbbi kayıtlardan hesaplanmış ve ≥0,36 puan kırılganlık olarak tanımlanmıştır. Sonuçlar: Yoğun bakım ünitesine yatırılan 53 artroplasti hastasının (ortalama yaş 76,4 ± 9,7) 8'inde (15,1%) erken postoperatif mortalite görülmüştür. Kırılganlık, mortalite ile güçlü bir şekilde ilişkiliydi. Kırılgan hastalarda mortalite oranı %38,9 iken, kırılgan olmayan hastalarda bu oran %2,9 idi (p = 0,0013). Bu istatistiksel olarak anlamlı fark 21,64'lük bir odds ratio ve 13,4'lük bir göreceli risk artışına karşılık geliyordu. Mortalite gelişen hastalar, daha yüksek komorbidite sayısı ve mFI değerleri sergilemişlerdir (p =0,007). Ancak yaş, cinsiyet ve cerrahi tipi ile önemli bir ilişki görülmemiştir. Revizyon prosedürleri sayısal olarak daha yüksek mortalite oranları sergilemiş olsa da bu fark istatistiksel olarak anlamlı değildir (p = 0,528). Sonuç: Frailty (mFI ≥ 0,36) yoğun bakım ünitesine yatırılan artroplasti hastalarında erken postoperatif mortalitenin en güçlü belirleyicisi olarak bulunmuştur. Yaş, cinsiyet ve cerrahi tipi mortalite üzerinde istatistiksel anlamlılık göstermemiştir. Kırılganlık değerlendirmesinin rutin preoperatif değerlendirmelere dahil edilmesi, yüksek riskli hastaların tespit edilmesine ve perioperatif optimizasyona rehberlik edilmesine yardımcı olabilir.

Keywords

• kırılganlık
• yoğun bakım
• artroplasti
• revizyon artroplasti
• kalça kırığı
• mortalite

Predictive value of Modified Frailty Index for early mortality in hip and knee arthroplasty patients admitted to intensive care unit

Abstract

Aims: With the expanding volume of hip and knee arthroplasty procedures, a growing proportion of patients present with comorbid conditions that may elevate their susceptibility to postoperative complications. The aim of this study was to investigate the relationship between preoperative frailty and early postoperative mortality (defined as death occurring during the ICU stay or within 7 days after surgery) in patients requiring ICU admission following hip or knee arthroplasty. Methods: This is a retrospective, exploratory study involving patients who underwent hip and knee arthroplasty at a single center between October 2023 and October 2024 and subsequently required intensive care unit admission during their first hospital stay. The 11-item Modified Frailty Index (mFI) was calculated from medical records, and a score of ≥0.36 was defined as frailty. Results: Of the 53 arthroplasty patients admitted to the ICU (mean age 76.4±9.7 years), early postoperative mortality occurred in 8 individuals (15.1%). Frailty was strongly associated with mortality, with rates of 38.9% in frail patients versus 2.9% in non-frail patients (p=0.0013), corresponding to an odds ratio of 21.64 and a relative risk of 13.4. Individuals who experienced mortality demonstrated significantly higher comorbidity counts and mFI values (both p=0.007), whereas age, sex, and surgical category showed no significant associations. Although revision procedures exhibited numerically higher mortality rates, this difference did not reach statistical significance (p=0.528). Conclusion: Frailty (mFI≥0.36) emerged as a strong predictor of early postoperative mortality within 7 days after surgery in ICU-admitted arthroplasty patients, exceeding the associations observed for age, sex, and surgical category. Incorporating frailty assessment into routine preoperative evaluations could help to identify high-risk individuals and guide perioperative optimization.

Keywords

• Frailty
• intensive care unit
• arthroplasty
• revision arthroplasty
• hip fracture
• mortality

References

1. Ayers DC, Yousef M, Zheng H, Yang W, Franklin PD. The prevalence and predictors of patient dissatisfaction 5-years following primary total knee arthroplasty. J Arthroplasty. 2022;37(6S):S121-S128. doi:10.1016/j.arth.2022.02.077
2. Roger C, Debuyzer E, Dehl M, et al. Factors associated with hospital stay length, discharge destination, and 30-day readmission rate after primary hip or knee arthroplasty: retrospective cohort study. Orthop Traumatol Surg Res. 2019;105(5):949-955. doi:10.1016/j.otsr.2019.04.012
3. Parvizi J, Ereth MH, Lewallen DG. Thirty-day mortality following hip arthroplasty for acute fracture. J Bone Joint Surg Am. 2004;86(9):1983-1988. doi:10.2106/00004623-200409000-00017
4. Forssten MP, Mohammad Ismail A, Ioannidis I, et al. The mortality burden of frailty in hip fracture patients: a nationwide retrospective study of cause-specific mortality. Eur J Trauma Emerg Surg. 2023;49(3): 1467-1475. doi:10.1007/s00068-022-02204-6
5. Singh JA, Lewallen DG. Ninety-day mortality in patients undergoing elective total hip or total knee arthroplasty. J Arthroplasty. 2012;27(8): 1417-1422. doi:10.1016/j.arth.2012.03.008
6. Jørgensen CC, Kehlet H, Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative group. Time course and reasons for 90-day mortality in fast-track hip and knee arthroplasty. Acta Anaesthesiol Scand. 2017;61(4):436-444. doi:10.1016/j.arth.2012.03.008
7. Jørgensen CC, Petersen MA, Kehlet H. Preoperative prediction of potentially preventable morbidity after fast-track hip and knee arthroplasty: a detailed descriptive cohort study. BMJ Open. 2016;6(1): e009813. doi:10.1136/bmjopen-2015-009813
8. Gillespie GN, Porteous AJ. Obesity and knee arthroplasty. Knee. 2007; 14(2):81-86. doi:10.1016/j.knee.2006.11.004

9. Memtsoudis SG, Pumberger M, Ma Y, et al. Epidemiology and risk factors for perioperative mortality after total hip and knee arthroplasty. J Orthop Res. 2012;30(11):1811-1821. doi:10.1002/jor.22139
10. Parvizi J, Mui A, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH. Total joint arthroplasty: when do fatal or near-fatal complications occur? J Bone Joint Surg Am. 2007;89(1):27-32. doi:10.2106/JBJS.E.01443
11. Ali AM, Bottle A. the validity of all-cause 30-day readmission rate as a hospital performance metric after primary total hip and knee arthroplasty: a systematic review. J Arthroplasty. 2019;34(8):1831-1836. doi:10.1016/j.arth.2019.04.011
12. Mancino F, Wall B, Bucher TA, Prosser GH, Yates PJ, Jones CW. The clinical Frailty Scale is a strong predictor of 1-year mortality in surgically managed hip periprosthetic fracture: an analysis from a high-volume institution. J Arthroplasty. 2024;39(5):1157-1164. doi:10.1016/j.arth.2023.11.010
13. Runner RP, Bellamy JL, Vu CCL, Erens GA, Schenker ML, Guild GN. Modified Frailty Index is an effective risk assessment tool in primary total knee arthroplasty. J Arthroplasty. 2017;32(9S):S177-S182. doi:10. 1016/j.arth.2017.03.046
14. Shin JI, Keswani A, Lovy AJ, Moucha CS. Simplified Frailty Index as a predictor of adverse outcomes in total hip and knee arthroplasty. J Arthroplasty. 2016;31(11):2389-2394. doi:10.1016/j.arth.2016.04.020
15. Bellamy JL, Runner RP, Vu CCL, Schenker ML, Bradbury TL, Roberson JR. Modified Frailty Index is an effective risk assessment tool in primary total hip arthroplasty. J Arthroplasty. 2017;32(10):2963-2968. doi:10. 1016/j.arth.2017.04.056
16. AbdelSalam H, Restrepo C, Tarity TD, Sangster W, Parvizi J. Predictors of intensive care unit admission after total joint arthroplasty. J Arthroplasty. 2012;27(5):720-725. doi:10.1016/j.arth.2011.09.027
17. Ali TZ, Lehman EB, Aziz F. Modified Frailty Index can be used to predict adverse outcomes and mortality after lower extremity bypass surgery. Ann Vasc Surg. 2018;46:168-177. doi:10.1016/j.avsg.2017.07.007
18. Ornaghi PI, Afferi L, Antonelli A, et al. Frailty impact on postoperative complications and early mortality rates in patients undergoing radical cystectomy for bladder cancer: a systematic review. Arab J Urol. 2020; 19(1):9-23. doi:10.1080/2090598X.2020.1841538
19. Schmucker AM, Hupert N, Mandl LA. The impact of frailty on short-term outcomes after elective hip and knee arthroplasty in older adults: a systematic review. Geriatr Orthop Surg Rehabil. 2019;10: 2151459319835109. doi:10.1177/2151459319835109
20. Bai Y, Zhang XM, Sun X, Li J, Cao J, Wu X. The association between frailty and mortality among lower limb arthroplasty patients: a systematic review and meta-analysis. BMC Geriatr. 2022;22(1):702. doi: 10.1186/s12877-022-03369-w
21. Pandit V, Tan TW, Kempe K, et al. Frailty syndrome in patients with lower extremity amputation: simplifying how we calculate frailty. J Surg Res. 2021;263:230-235. doi:10.1016/j.jss.2020.12.038
22. Laursen CC, Meyhoff CS, Petersen TS, Jimenez-Solem E, Sørensen AMS, Lunn TH. Fatal outcome and intensive care unit admission after total hip and knee arthroplasty: an analytic of preoperative frailty and comorbidities. Acta Anaesthesiol Scand. 2021;65(10):1390-1396. doi:10. 1111/aas.13950
23. George EL, Hall DE, Youk A, et al. Association between patient frailty and postoperative mortality across multiple noncardiac surgical specialties. JAMA Surg. 2021;156(1):e205152. doi:10.1001/jamasurg.2020.5152
24. Garcia AR, Quan T, Mikula JD, Mologne MS, Best MJ, Thakkar SC. Higher Modified Frailty Index score is associated with 30-day postoperative complications following simultaneous bilateral total knee arthroplasty. Knee. 2024;50:88-95. doi:10.1016/j.knee.2024.07.019
25. Zamanzadeh RS, Seilern Und Aspang JRM, Schwartz AM, Martin JR, Premkumar A, Wilson JM. Age-adjusted Modified Frailty Index predicts 30-day complications and mortality in aseptic revision total hip and knee arthroplasty. J Arthroplasty. 2024;39(1):198-205. doi:10.1016/j.arth.2023.06.032
26. Traven SA, Reeves RA, Slone HS, Walton ZJ. Frailty predicts medical complications, length of stay, readmission, and mortality in revision hip and knee arthroplasty. J Arthroplasty. 2019;34(7):1412-1416. doi:10.1016/ j.arth.2019.02.060
27. Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients. J Orthop Trauma. 2014;28(3):e49-e55. doi:10.1097/BOT.0b013e3182a5a045
28. Kelly B, Stratigakis N, Sayyed A, et al. Current state of frailty in revision arthroplasty. Knee Surg Relat Res. 2024;36(1):39. doi:10.1186/s43019-024-00245-2
29. Pridham G, Rockwood K, Rutenberg AD. Dynamical modelling of the frailty index indicates that health reaches a tipping point near age 75. arXiv Preprint. 2024;arXiv2412.07795. doi:10.48550/arXiv.2412.07795
30. Belmont PJ, Goodman GP, Hamilton W, Waterman BR, Bader JO, Schoenfeld AJ. Morbidity and mortality in the thirty-day period following total hip arthroplasty: risk factors and incidence. J Arthroplasty. 2014;29(10):2025-2030. doi:10.1016/j.arth.2014.05.015