A modified frailty index predicts complication, readmission, and 30-day mortality following the revision total hip arthroplasty

David Momtaz; Shawn Okpara; Armando Martinez; Tucker Cushing; Abdullah Ghali; Rishi Gonuguntla; Travis Kotzur; Anthony Duruewuru; Madison Harris; Ali Seifi; Melvyn Harrington

doi:10.1186/s42836-024-00232-8

A modified frailty index predicts complication, readmission, and 30-day mortality following the revision total hip arthroplasty

Arthroplasty. 2024 Feb 4;6(1):7. doi: 10.1186/s42836-024-00232-8.

Affiliations

¹ Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA.
² Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA. ghaliabdullah@gmail.com.

Abstract

Introduction: This study aimed to develop a modified frailty index (MFI) to predict the risks of revision total hip arthroplasty (THA).

Methods: Data from the American College of Surgeons - National Surgical Quality Improvement Program were analyzed for patients who underwent revision THA from 2015 to 2020. An MFI was composed of the risk factors, including severe obesity (body mass index > 35), osteoporosis, non-independent function status prior to surgery, congestive heart failure within 30 days of surgery, hypoalbuminemia (serum albumin < 3.5), hypertension requiring medication, type 1 or type 2 diabetes, and a history of chronic obstructive pulmonary disease or pneumonia. The patients were assigned based on the MFI scores (MFI0, no risk factor; MFI1, 1-2 risk factors; MFI2, 3-4 risk factors; and MFI3, 5+ risk factors). Confidence intervals were set at 95% with a P value less than or equal to 0.05 considered statistically significant.

Results: A total of 17,868 patients (45% male, 55% female) were included and had an average age of 68.5 ± 11.5 years. Odds of any complication, when compared to MFI0, were 1.4 (95% CI [1.3, 1.6]) times greater for MFI1, 3.2 (95% CI [2.8, 3.6]) times greater for MFI2, and 10.8 (95% CI [5.8, 20.0]) times greater for MFI3 (P < 0.001). Odds of readmission, when compared to MFI0, were 1.4 (95% CI [1.3, 1.7]) times greater for MFI1, 2.5 (95% CI [2.1, 3.0]) times greater for MFI2, and 4.1 (95% CI [2.2, 7.8]) times greater for MFI3 (P < 0.001).

Conclusion: Increasing MFI scores correlate with increased odds of complication and readmission in patients who have undergone revision THA. This MFI may be used to predict the risks after revision THA.

Keywords: MFI; Modified frailty index; Operative risk factors; Orthopaedics; Orthopedics; Revision; Risk assessment; Surgery; Total hip arthroplasty.