Association of a Modified Frailty Index with Postoperative Outcomes after Ankle Fractures in Patients Aged 55 and Older Rishin J. Kadakia MD; Cathy Vu MD; Andrew Pao MD; Shay Tenenbaum MD, Jason T. Bariteau MD AOFAS Annual Meeting 2017 July 12 15 Seattle, Washington
Disclosure NO CONFLICT TO DISCLOSE Association of a Modified Frailty Index with Postoperative Outcomes after Ankle Fractures in Patients Aged 50 and Older Rishin J. Kadakia MD Cathy Vu MD Andrew Pao MD Shay Tenenbaum MD Jason T. Bariteau MD Our disclosures in the Final AOFAS Mobile App. We have no potential conflicts with this presentation.
The Aging Population The elderly population is rapidly growing Age Groups as a Percentage of Total Population in the USA Sporer SM, Weinstein JN, Koval KJ. The geographic incidence and treatment variation of common fractures of elderly patients. J. Am. Acad. Orthop. Surg. 2006;14(4):246-255. Hobbs F, Stoops N. Demographic Trends in the 20 th Century, U.S. Census Bureau, Census 2000 Special Reports, CENSR-4 Table5, November 2002, https://www.census.gov/prod/2002pubs/censr-4.pdf Ankle fractures are the third most common fracture in the elderly
Physiologic Age Healthier lifestyles and medical advancements has a created a generation of healthier and more active elderly individuals The elderly population is a spectrum of patients ranging from those with several comorbidities to those physiologically very healthy Is a patient s age still a reliable tool for risk stratification alone in today s world?
Frailty Defined: Decrease in physiologic reserve as well as multisystem impairments which is separate from the normal process of aging There are several validated frailty scoring systems used in clinical research The Modified Frailty Index (MFI) is an example that is frequently used Increased scores on the MFI have been shown to predictive of poor postoperative outcomes in several surgical subspecialties
Purpose Determine if there is a relationship between frailty and postoperative outcomes in elderly patients with ankle fractures
Methods Design & Population: Retrospective (2005 2014) National Surgical Quality Improvement (NSQIP) database Collects demographic, preoperative factors, and postoperative outcomes within 30 days Patients identified by CPT codes Patients > 55 years of age included in the study Postoperative complications: infections, wound complications, medical complications MFI score and ASA class calculated using collected variables Statistics: Bivariate and Multivariate logistic analysis was used to determine relationship between postoperative outcomes and the MFI score Collected Variables: Wound class, age, demographics, comorbidities 30 day-reoperation rates, postoperative complications, hospital/icu length of stay, readmissions Study Population N (%) Total 6749 Age, years ( SD) 64.4 (10.3) Male 2194 (32.5)
MFI and postoperative outcomes Increasing MFI associated with increased incidence of postoperative complications Mean length of stay (days) 7 6 5 4 3 2 Hospital stay ICU stay Complications (%) 20.00 18.00 16.00 14.00 12.00 10.00 8.00 6.00 4.00 2.00 0.00 Infection Wound Cardiac Pulmonary Heme Renal Reoperation Readmission 0.00 0.09 0.18 0.27+ MFI score Increasing MFI associated with increased hospital and ICU length of stay 1 0 0 0.09 0.18 0.27+ MFI score
MFI and postoperative outcomes Odds Ratio 95% CI p value Secondary Outcomes Infection 1.46 1.21-1.77 <0.001 Wound 1.59 1.21-2.08 0.001 Medical Complication Cardiac 2.64 1.70-4.09 <0.001 Pulmonary 1.88 1.42-2.50 <0.001 Renal 3.08 1.45-6.54 0.003 Hematologic 1.45 1.01-2.07 0.042 Reoperation 1.78 1.50-2.12 <0.001 Readmission 2.21 1.57-3.10 <0.001 Bivariate Analysis: Each unit increase in MFI score was associated with significantly increased odds ratio of all outcomes of interest
Multivariable analysis: 30 day reoperation Variable Odds Ratio 95% CI p value Modified frailty index 17.74 2.63-119.66 0.003 Age 1.02 1.00-1.04 0.018 ASA Class 1 Reference 2 1.21 0.47-3.10 0.690 3 1.98 0.76-5.15 0.160 4-5 2.34 0.77-7.09 0.132 Wound Class I Reference II 1.58 0.63-3.93 0.328 III 4.27 2.40-7.58 <0.001 IV 6.91 3.28-14.57 <0.001 Gender (Reference=male) 0.79 0.55-1.13 0.195 Higher MFI scores associated with increased 30 day reoperation rates
Conclusions Elderly patient population consists of a spectrum of patients and age alone may not enough for risk stratification Frailty accounts for age, comorbidities, and the patient s overall well-being concept of physiologic age Modified Frailty Index can be used to predict postoperative outcomes following surgical fixation of ankle fractures in older patients Useful adjuvant when considering surgical morbidity and when discussing outcomes with patients and families
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