TY - JOUR
T1 - Frailty Transitions One Year After Total Joint Arthroplasty
T2 - A Cohort Study
AU - Johnson, Rebecca L.
AU - Frank, Ryan D.
AU - Abdel, Matthew P.
AU - Habermann, Elizabeth B.
AU - Chamberlain, Alanna M.
AU - Mantilla, Carlos B.
N1 - Funding Information:
This project was supported by a Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery award, Mayo Clinic Department of Development Benefactor Gift, and through the Department of Anesthesiology and Perioperative Medicine Small Grants Program. The authors wish to acknowledge the Anesthesia Clinical Research Unit and the expert program analysts within Health Sciences Research Departments at Mayo Clinic, Rochester, MN. We wish to recognize Ms Youlonda A. Loechler within the Department of Orthopedic Surgery for her expertise in data contained within the Total Joint Registry and Ms. Madeline Johnson, doctoral student in Biomedical Statistics and Informatics, for her participation in preliminary analyses for this project. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Funding Information:
This project was supported by a Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery award, Mayo Clinic Department of Development Benefactor Gift, and through the Department of Anesthesiology and Perioperative Medicine Small Grants Program. The authors wish to acknowledge the Anesthesia Clinical Research Unit and the expert program analysts within Health Sciences Research Departments at Mayo Clinic, Rochester, MN.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/1
Y1 - 2022/1
N2 - Background: Total joint arthroplasty (TJA) is prevalent and offered to patients regardless of frailty status experiencing pain, disability, and functional decline. This study aims to describe changes in levels of frailty 1 year after TJA. Methods: We identified a retrospective cohort of adult patients undergoing primary TJA between 2005 and 2016 using an institutional total joint registry. Associations between categorized frailty deficit index (FI) and change in FI were analyzed using linear regression models. Mortality, deep periprosthetic joint infection, and reoperation were analyzed using time to event methods. Results: In total, 5341 patients (37.6% non-frail, 39.4% vulnerable, and 23.0% frail) with items necessary to determine FI at 1 year after TJA were included. Preoperatively, 29% of vulnerable patients improved to non-frail 1 year later, compared to only 11% regressing to frail. Four in 10 frail patients improved to vulnerable/non-frail. Improvements in activities of daily living (ADL) were more evident in frail and vulnerable patients, with >30% reduction in the percentage of patients expressing difficulties with walking, climbing stairs, and requiring ADL assistance 1 year after TJA. Increases in frailty 1 year after TJA were associated with significantly increased rates of mortality (hazard ratio [HR] 1.50, 95% confidence interval [CI] 1.24-1.82, P < .001), deep periprosthetic joint infection (HR 3.98, 95% CI 1.85-8.58, P < .001), and reoperation (HR 1.80, 95% CI 1.19-2.72, P = .005). Conclusion: Frailty states are dynamic with patient frailty shown to be modifiable 1 year after TJA. Preoperative frailty measurement is an important step toward identifying those that may benefit most from TJA and for postoperative frailty surveillance.
AB - Background: Total joint arthroplasty (TJA) is prevalent and offered to patients regardless of frailty status experiencing pain, disability, and functional decline. This study aims to describe changes in levels of frailty 1 year after TJA. Methods: We identified a retrospective cohort of adult patients undergoing primary TJA between 2005 and 2016 using an institutional total joint registry. Associations between categorized frailty deficit index (FI) and change in FI were analyzed using linear regression models. Mortality, deep periprosthetic joint infection, and reoperation were analyzed using time to event methods. Results: In total, 5341 patients (37.6% non-frail, 39.4% vulnerable, and 23.0% frail) with items necessary to determine FI at 1 year after TJA were included. Preoperatively, 29% of vulnerable patients improved to non-frail 1 year later, compared to only 11% regressing to frail. Four in 10 frail patients improved to vulnerable/non-frail. Improvements in activities of daily living (ADL) were more evident in frail and vulnerable patients, with >30% reduction in the percentage of patients expressing difficulties with walking, climbing stairs, and requiring ADL assistance 1 year after TJA. Increases in frailty 1 year after TJA were associated with significantly increased rates of mortality (hazard ratio [HR] 1.50, 95% confidence interval [CI] 1.24-1.82, P < .001), deep periprosthetic joint infection (HR 3.98, 95% CI 1.85-8.58, P < .001), and reoperation (HR 1.80, 95% CI 1.19-2.72, P = .005). Conclusion: Frailty states are dynamic with patient frailty shown to be modifiable 1 year after TJA. Preoperative frailty measurement is an important step toward identifying those that may benefit most from TJA and for postoperative frailty surveillance.
KW - activities of daily living
KW - frailty
KW - outcomes
KW - perioperative complications
KW - total joint arthroplasty
UR - http://www.scopus.com/inward/record.url?scp=85115610310&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85115610310&partnerID=8YFLogxK
U2 - 10.1016/j.arth.2021.08.022
DO - 10.1016/j.arth.2021.08.022
M3 - Article
C2 - 34531097
AN - SCOPUS:85115610310
SN - 0883-5403
VL - 37
SP - 10-18.e2
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 1
ER -