Frailty assessment as a predictor of postoperative complications and life space in Indian older adults undergoing elective major orthopaedic surgery: A prospective study from a tertiary care centre

Abstract

Introduction

Preoperative risk assessment is important, and the traditional evaluation is ineffective in identifying frail older patients. We intend to report the association between frailty, as diagnosed using the National Surgical Quality Improvement Program (NSQIP) modified frailty index, and immediate and one-month postoperative outcome in older adults undergoing elective orthopaedic surgery.

Methods

This prospective study was conducted in the inpatient department of a tertiary care centre. The preoperative data along with comorbidity, frailty and other geriatric syndromes were collected from 100 older adults, undergoing elective orthopaedic surgery. The outcomes were day 3 postoperative complications such as delirium, electrolyte imbalance, acute kidney injury, pulmonary embolism, intensive care unit admission and infection. Mobility, and mortality were assessed on 30^th post-operative day.

Results

The mean age of the study population was 67.8±6.75 years, 80 % were between the age of 60-74 years, 55 (55 %) were females, 28 patients were frail. Hypertension (n = 48) was the most prevalent comorbidity, followed by diabetes (n = 29). Among the immediate post-operative complications, frail patients had higher risk of hyponatremia (OR: 39.44; CI: 4.84-1734.41), acute kidney injury (OR: 6.8; CI: 1.58-33.37), delirium (OR: 23; CI: 5.23-134.84), and infection (OR: 9.44; CI: 2.32-44.87). At 30-day post-operative day frail patients had poor mobility (18.05±8.4 vs 24.45±5.6).

Conclusion

Frailty is an important predictor of immediate and short-term post-operative complications in older adults undergoing major elective orthopaedic surgery. Pre-operative screening for frailty could help focus care towards vulnerable patients and prevent adverse events during post-operative period.