Modified frailty index is a useful predictor for complications following total elbow arthroplasty in all populations.

Abstract

Background: This retrospective review aimed to specify whether the 5-item modified frailty index (mFI-5) is a valid measure for surgeons when assessing the likelihood of complications in patients undergoing total elbow arthroplasty (TEA).

Methods: TEA patients 50 years or older were identified from the NSQIP database from 2006 to 2019. Patients were stratified based on age to create a 50+, a 65+, and an 80-89-year-old cohort. Thirty-day outcomes assessed in this study included mortality, unplanned readmission, return to the operating room, urinary tract infection, bleeding requiring transfusion, prolonged hospital stay, and discharge to a location other than home. The mFI-5 was calculated based on the sum of the presence of five comorbidities. Bivariate and multivariate analyses compared the complication rates among mFI-5 scores.

Results: The study included a total of 614 TEA patients aged 50 years or older. Following adjustment, patients older than 50 with mFI-5 = 1 had an increased risk of being discharged to a non-home location compared to patients with mFI-5 = 0 (odds ratio (OR) 3.27). Compared to patients with mFI-5 = 0, those with mFI-5 = 2 or greater had an increased risk of bleeding requiring transfusion (OR 5.13), prolonged hospital stay (> 5 days) (OR 5.83), and discharge to a non-home destination (OR 9.88). Relative to patients with mFI-5 = 1, those with mFI-5 = 2 or greater were more likely to have prolonged hospital stay (OR 3.07) and discharge to a non-home location (OR 3.05). Patients older than 65 and patients in the 80-89-year-old cohort with mFI-5 = 2 were also more likely to have a non-home discharge (OR 10.40 and 21.84, respectively).

Conclusion: Higher mFI-5 scores in patients aged 50 and older were associated with worse postoperative outcomes including non-home discharge, transfusion likelihood, and prolonged hospitalization. Similar trends were observed in both the 65 + and 80-89-year-old cohorts regarding the risk of non-home discharge, however, higher mFI-5 scores in these older groups did not have an increased likelihood of postoperative transfusion or prolonged hospital stay.