Frailty is a predictor of immediate postoperative complications following surgical management of knee dislocations

Victor Koltenyuk; Matthew Merckling; Michael Li; Zachary Chanmin; Jay B Butler

doi:10.1007/s00590-024-03941-7

Frailty is a predictor of immediate postoperative complications following surgical management of knee dislocations

Eur J Orthop Surg Traumatol. 2024 Apr 20. doi: 10.1007/s00590-024-03941-7. Online ahead of print.

Authors

Victor Koltenyuk¹, Matthew Merckling², Michael Li², Zachary Chanmin³, Jay B Butler⁴

Affiliations

¹ School of Medicine, Westchester Medical Center, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY, 10595, USA. vkolteny@student.nymc.edu.
² School of Medicine, Westchester Medical Center, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY, 10595, USA.
³ College of Osteopathic Medicine, New York Institute of Technology, Glen Head, NY, USA.
⁴ Orthopedic and Fracture Specialists, Portland, OR, USA.

PMID: 38643261
DOI: 10.1007/s00590-024-03941-7

Abstract

Purpose: To assess the utility of frailty in predicting outcomes following surgical intervention for KDs.

Methods: The NIS database was queried for non-congenital knee dislocations from 2015 to 2019 that underwent ligament repair or surgical reduction. Patients were assigned frailty scores using the mFI-11, and outcomes were compared. Multivariate regression and ROC curve analysis were used to assess the independent association of obesity, frailty, VI, and age with adverse outcomes.

Results: A total of 3797 patients who underwent surgical management were included. Frailty was associated with extended LOS (OR 1.353, 95% CI 1.212-1.510, p < 0.001), adverse discharge (OR 1.716, 95% CI 1.515-1.946, p < 0.001), and complications (OR 1.449, 95% CI 1.352-1.553, p < 0.001). Severely frailty was associated with extended LOS (OR 1.838, 95% CI 1.611-2.097, p < 0.001), adverse discharge (OR 2.756, 95% CI 2.394-3.171, p < 0.001), and complications (OR 1.603, 95% CI 1.453-1.768, p < 0.001). Additionally, VI was a risk factor for extended LOS (OR 7.647 (6.442-9.076) p < 0.001), complications (OR 2.065 (1.810-2.341) p < 0.001), and adverse discharge (OR 1.825 (1.606-2.075), p < 0.001). Obesity was a risk factor for extended LOS (OR 1.599 (1.470-1.739), p < 0.001) and complications (OR 1.235 (1.108-1.377), p < 0.001). AUC analysis showed that frailty was the most accurate predictor of all outcomes when compared to VI, obesity, and age.

Conclusions: Frailty is superior to age and obesity, and comparable to VI, at predicting adverse outcomes following surgical management of KDs. These findings suggest that frailty assessment might play a role in risk stratification and preoperative planning for KD patients that require surgical intervention.

Keywords: Complications; Frailty; Knee dislocation; Obesity; Vascular injury.