Deciphering the Frailty Factor: Comprehensive Insights Into Its Impact on Postoperative Complications and Recovery Among Elderly Orthopedic Surgery Patients.

Abstract

Background: This single center-based prospective cohort study was conducted, on 157 patients over 60 years old patients requiring major orthopedic surgery, from June 2019 to June 2021. Frailty was assessed using the Edmonton Frailty Scale pre-operatively. Post-operative complications, ambulatory status, readmission rates, and mortality were monitored up to three months post-surgery, and statistical analysis was performed.

Materials and methods: With India's elderly population projected to reach 324 million by 2050, the prevalence of orthopedic surgeries among this demographic is increasing. frailty, a measure of decreased strength, endurance, and physiological function with aging, may significantly affect surgical outcomes. This study aimed to evaluate the correlation between frailty, as measured by the Edmonton Frailty Scale, and postoperative outcomes in elderly patients undergoing major orthopedic surgeries.

Results: The study found that 60% of patients were categorized as either vulnerable or frail. Surgical site infection (15.9%) was the most common postoperative complication across all frailty levels. Cardiac complications and deep vein thrombosis were significantly associated with higher frailty levels. At discharge, 78% of patients were ambulatory, improving to over 91% at the three-month follow-up. However, frailty significantly delayed recovery to ambulatory status. The incidence of death during the study was 3.2%, and readmission within 30 days post-surgery was 3.8%. Statistical analysis revealed significant differences between frailty levels and post-operative complications, ambulatory status, and, to a lesser extent, readmission, and mortality rates.

Conclusion: The study demonstrates a significant correlation between frailty and adverse postoperative outcomes in elderly patients undergoing major orthopedic surgeries. It underscores the necessity of incorporating frailty assessment into preoperative evaluations to tailor care plans and improve surgical outcomes. Tailored rehabilitation programs and preoperative optimization may mitigate the risks associated with frailty, enhancing recovery and reducing the burden of postoperative complications and readmission.