Impact of the hospital frailty risk score on outcomes following primary total elbow arthroplasty

IF 2.9 2区医学 Q1 ORTHOPEDICS Journal of Shoulder and Elbow Surgery Pub Date : 2025-02-01 DOI:10.1016/j.jse.2024.08.019

Grace Bennfors MD, John W. Moore BS, Alexander S. Guareschi MD, Brandon L. Rogalski MD, Josef K. Eichinger MD, Richard J. Friedman MD, FRCSC

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Abstract

Background

The Hospital Frailty Risk Score (HFRS) has demonstrated strong correlation with adverse outcomes in various joint replacement surgeries, yet its applicability in total elbow arthroplasty (TEA) remains unexplored. The purpose of this study is to assess the association between HFRS and postoperative complications following elective primary TEA.

Methods

The Nationwide Readmissions Database was queried to identify patients undergoing primary TEA from 2016-2020. The HFRS was used to compare medical, surgical, and clinical outcomes of frail vs. nonfrail patients. Mean and relative costs, total hospital length of stay, and discharge disposition for frail and nonfrail patients were also compared.

Results

We identified 2049 primary TEA in frail patients and 3693 in nonfrail patients. Frail patients had increased complication rates including acute respiratory failure (13.6% vs. 1.1%; P < .001), urinary tract infections (12.3% vs. 0.0%; P < .001), transfusions (3.9% vs. 1.1%; P < .001), pneumonia (1.1% vs. 0.2%; P < .001), acute respiratory distress syndrome (3.2% vs. 0.6%; P < .001), sepsis (0.7% vs. 0.1%; P < .001), and hardware failure (1.2% vs. 0.1%; P < .001). Frail patients also experienced higher rates of readmission (37% vs. 25%; P < .001) and death (1.7% vs. 0.2%; P < .001), while being less likely to undergo revision (6.5% vs. 17%; P < .001). Frail patients incurred higher health-care costs ($28,497 vs. $23,377; P < .001) and longer length of stay (5.3 days vs. 2.6 days; P < .001), with reduced likelihood of routine hospital stays (36% vs. 71%; P < .001) and increased utilization of short-term hospitalization (P < .001), care facilities (P < .001), and home health-care services (P < .001).

Conclusion

HFRS is a validated indicator of frailty and is strongly associated with increased rates of complications in patients undergoing elective primary TEA. These findings should be considered by orthopedic surgeons when assessing surgical candidacy and discussing treatment options in this at-risk patient population.

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医院虚弱风险评分对初次全肘关节置换术后疗效的影响

背景：医院虚弱风险评分（HFRS）已被证明与各种关节置换手术的不良预后密切相关，但其在全肘关节置换术（TEA）中的适用性仍有待探索。本研究旨在评估 HFRS 与选择性初级 TEA 术后并发症之间的关系：方法：查询全国再入院数据库，以确定 2016 年至 2020 年期间接受初级 TEA 的患者。HFRS 用于比较体弱与非体弱患者的内科、外科和临床结果。此外，还比较了体弱和非体弱患者的平均和相对费用、总住院时间（LOS）和出院处置：我们在体弱患者中发现了 2,049 例原发性 TEA，在非体弱患者中发现了 3,693 例原发性 TEA。体弱患者的并发症发生率增加，包括急性呼吸衰竭（13.6% vs. 1.1%；p < 0.001）、尿路感染（12.3% vs. 0.0%；p < 0.001）、输血（3.9% vs. 1.1%；P < 0.001）、肺炎（1.1% vs. 0.2%；P < 0.001）、急性呼吸窘迫综合征（3.2% vs. 0.6%；P < 0.001）、败血症（0.7% vs. 0.1%；P < 0.001）和硬件衰竭（1.2% vs. 0.1%；P < 0.001）。体弱患者的再入院率（37% vs. 25%; p < 0.001）和死亡率（1.7% vs. 0.2%; p < 0.001）也较高，但进行翻修的可能性较低（6.5% vs. 17%; p < 0.001）。体弱患者的医疗费用更高（28,497美元对23,377美元；p < 0.001），住院时间更长（5.3天对2.6天；p < 0.001），常规住院的可能性更低（36%对71%；p < 0.001），短期住院（p < 0.001）、护理机构（p < 0.001）和家庭医疗服务（p < 0.001）的使用率更高：结论：HFRS是一项有效的虚弱指标，与接受择期原发性TEA手术的患者并发症发生率增加密切相关。骨科医生在评估手术候选资格和讨论这类高危患者的治疗方案时应考虑这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Shoulder and Elbow Surgery 医学-外科

CiteScore

6.50

自引率

23.30%

发文量

604

审稿时长

11.2 weeks

期刊介绍： The official publication for eight leading specialty organizations, this authoritative journal is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow. Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. Journal of Shoulder and Elbow Surgery features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty, and rehabilitation.

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