Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2018

Open Access 01-12-2018 | Research article

Frailty as a predictor of hospital length of stay after elective total joint replacements in elderly patients

Authors: Han Ting Wang, Josée Fafard, Stéphane Ahern, Pascal-André Vendittoli, Paul Hebert

Published in: BMC Musculoskeletal Disorders | Issue 1/2018

Login to get access

Abstract

Background

Total joint replacement procedures are increasing in number because of population aging and osteoarthritis development. Defined as a lack of physiological reserves and the inability to adequately respond to external stressors, frailty may be more common than expected in older patients with degenerative arthritis awaiting total joint replacements.
The aim of the present study was to assess associations between frailty and adverse outcomes, frailty prevalence among elderly patients awaiting elective TJR, and agreement between 2 frailty screening instruments.

Methods

We undertook a prospective, observational, pilot study in our institution. We enrolled patients 65 years or older who were awaiting elective knee or hip replacement surgery and evaluated them in our preoperative clinic with planned postoperative hospital length of stay greater than 24 h. Patients were asked to grade their perceived well-being on the Clinical Frailty Scale and to answer questions on the FRAIL Scale.

Results

The Clinical Frailty Scale classified 40 patients (45.9%) as robust, 43 patients (49.4%) as prefrail and 4 patients (4.5%) as frail, while the FRAIL Scale categorized 12 patients (13.7%) as robust, 54 patients (62.0%) as prefrail, and 20 patients (22.9%) as frail. Robustness, ascertained on the Clinical Frailty Scale was, while the FRAIL Scale was not, significantly associated with shorter hospital length of stay and fewer discharges to the rehabilitation center. Both scales showed moderate mutual agreement.

Conclusion

Screening for frailty identified between 5% and 10% of patients at risk of adverse outcomes. The Clinical Frailty Scale was, while the FRAIL scale was not, significantly associated with hospital length of stay and discharge to rehabilitation center in our cohort of total joint replacement patients.
Literature
1.
2.
Romero-Artuno R, Kenny RA. The frailty index in Europeans: association with age and mortality. Age Ageing. 2012;41(5):684–98.CrossRef
3.
Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, Schols JM. Toward a conceptual definition of frail community dwelling older people. Nurs Outlook. 2010;58(2):76–86.CrossRefPubMed
4.
5.
Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60(8):1487–92.CrossRefPubMed
6.
Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210(6):901–8.CrossRefPubMed
7.
Afilalo J, Mottillo S, Eisenberg MJ, Alexander KP, Noiseux N, Perrault LP, et al. Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcomes. 2012;5(2):222–8.CrossRefPubMed
8.
Ganapathi AM, Englum BR, Hanna JM, Schechter MA, Gaga JG, Hurwitz LM, et al. Frailty and risk in proximal aortic surgery. J Thorac Cardiovasc Surg. 2014;147(1):186–91.CrossRefPubMed
9.
Buigues C, Juarros-Folgado P, Fernande-Garrido J, Navarro-Martinez R, Cauli O. Frailty syndrome and risk of pre-operative evaluation: a systematic review. Arch Gerontol Geriatr. 2015;61(3):309–21.CrossRefPubMed
10.
Cigolle CT, Ofstedal MB, Tian Z, Blaum CS. Comparing models of frailty: the health and retirement study. J Am Geriatr Soc. 2009;57(5):830–9.CrossRefPubMed
11.
Ibrahim MS, Twaij H, Giebaly DE, Nizam I, Haddad FS. Enhanced recovery in total hip replacement: a clinical review. Bone Joint J. 2013;95-B(12):1587–94.CrossRefPubMed
12.
Snow R, Granata J, Ruhil AV, Vogel K, McShane M, Wasielewski R. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement. J Bone Joint Surg Am. 2014;96(19):e165.CrossRefPubMed
13.
Kehlet H, Thienpont E. Fast-track Knee arthroplasty – status and future challenges. Knee. 2013;20(Suppl 1):S29–33.CrossRefPubMed
14.
Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging research conference on frailty in older adults. J Am Geriatr Soc. 2006;54(6):991–1001.CrossRefPubMed
15.
Mitniski AB, Graham JE, Mogilner AJ, Rockwood K. Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC Geriatr. 2002;27(2):1–8.CrossRef
16.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.CrossRefPubMed
17.
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.CrossRefPubMedPubMedCentral
18.
Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B. The I.A.N.A task force on frailty assessment of older people in clinical practice. J Nutr Health Aging. 2008;12(1):29–37.CrossRefPubMed
19.
Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601–8.CrossRefPubMedPubMedCentral
20.
Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59(3):255–63.CrossRefPubMed
21.
Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–51.CrossRefPubMed
22.
Brorsson B, Asberg KH. Katz Index of independence in ADL. Reliability and validity in short-term care. Scand J Rehabil Med. 1984;16(3):125–32.PubMed
23.
Lovald ST, Ong KL, Malkani AL, Lau EC, Schmier JK, Kurtz SM, et al. complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. J Arthroplast. 2004;29(3):510–5.CrossRef
24.
Cook JR, Warren M, Ganley KJ, Prefontaine P, Wylie JW. A comprehensive joint replacement program for total knee arthroplasty: a descriptive study. BMC Musculoskelet Disord. 2008;9(154)
25.
Hart A, Bergeron SG, Epure L, Huk O, Zukor D, Antoniou J. Comparison of US and Canadian perioperative outcomes and hospital efficiency after Total hip and knee arthroplasty. JAMA Surg. 2015;150(10):990–8.CrossRefPubMed
26.
McIsaac DI, Beaule PE, Bryson GL, Van Walraven C. The impact of frailty on outcomes and healthcare resource usage after total joint arthroplasty: a population-based cohort study. Bone Joint J. 2016;98-B(6):799–805.CrossRefPubMed
27.
Cooper Z, Rogers SO Jr, Ngo L, Guess J, Schmitt E, Jones RN, et al. Comparison of frailty measures as predictors of outcomes after orthopedic surgery. J Am Geriatr Soc. 2016;64(12):2464–71.CrossRefPubMedPubMedCentral
28.
Afilalo J. Conceptual models of frailty: the sarcopenia phenotype. Can J Cardiol. 2016;32:1051–5.CrossRefPubMed
29.
Carson JL, Terrin ML, Noveck H, Sanders DW, Chaitman BR, Rhoads GG, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011;365(26):2453–62.CrossRefPubMedPubMedCentral
30.
Bohl DD, Shen MR, Kayupov E, Cvetanovich GL, Della Valle CJ. Is hypoalbuminemia associated with septic failure and acute infection after revision Total joint arthroplasty? A study of 4517 patients from the National Surgical Quality Improvement Program. J Arthroplast. 2016;31(5):963–7.CrossRef
Metadata
Title
Frailty as a predictor of hospital length of stay after elective total joint replacements in elderly patients
Authors
Han Ting Wang
Josée Fafard
Stéphane Ahern
Pascal-André Vendittoli
Paul Hebert
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2018
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-018-1935-8

Other articles of this Issue 1/2018

BMC Musculoskeletal Disorders 1/2018 Go to the issue

Research article

Clinical outcomes of arthroscopic rotator cuff repair: a retrospective comparison of double-layer, double-row and suture bridge methods

Research article

Validation of the Polish version of the Western Ontario Rotator Cuff Index in patients following arthroscopic rotator cuff repair

Research article

Triamcinolone Acetonide affects TGF-β signaling regulation of fibrosis in idiopathic carpal tunnel syndrome

Research article

Efficacy and safety of oral compared with intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty: a meta-analysis

Research article

The prevalence and under-diagnosis of vertebral fractures on chest radiograph

Research article

Risk factors for neck pain among forklift truck operators: a retrospective cohort study