title: The impact of frailty on outcomes and healthcare resource usage after total joint arthroplasty: a population-based cohort study.
abstract: OBJECTIVE
  Total joint arthroplasty (TJA) is commonly performed in elderly patients. Frailty, an aggregate expression of vulnerability, becomes increasingly common with advanced age, and independently predicts adverse outcomes and the use of resources after a variety of non-cardiac surgical procedures. Our aim was to assess the impact of frailty on outcomes after TJA.
  
  
  METHODS
  We analysed the impact of pre-operative frailty on death and the use of resources after elective TJA in a population-based cohort study using linked administrative data from Ontario, Canada.
  
  
  RESULTS
  Of 125 163 patients aged > 65 years having elective TJA, 3023 (2.4%) were frail according to the Johns Hopkins ACG frailty-defining diagnoses indicator. One year follow-up was complete for all patients. Frail patients had a higher adjusted one year risk of mortality (hazard ratio 3.03, 95% confidence interval (CI) 2.62 to 3.51), a higher rate of admission to intensive care (odds ratio (OR) 2.52, 95% CI 2.21 to 2.89), increased length of stay (incidence rate ratio 1.62, 95% CI 1.59 to 1.65), a higher rate of discharge to institutional care (OR 2.09, 95% CI 1.93 to 2.25), a higher rate of re-admission (OR 1.33, 95% CI 1.07 to 1.66) and increased costs at 30, 90 and 365 days post-operatively. Frailty affected outcomes after total hip arthroplasty more than after total knee arthroplasty.
  
  
  CONCLUSIONS
  Frailty is an important risk factor for death after elective TJA, and increases post-operative resource utilisation across many metrics. Processes to optimise the outcomes and efficiency of TJA in frail patients are needed. Cite this article: Bone Joint J 2016;98-B:799-805.
authors.affiliation: The Ottawa Hospital, Civic Campus, Room B311, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada.
authors.forename: D I
authors.initials: DI
authors.lastname: McIsaac
authors.affiliation: University of Ottawa, 501 Smyth Rd, CCW 1646, Ottawa ON, KiH 8L6, Canada.
authors.forename: P E
authors.initials: PE
authors.lastname: Beaulé
authors.affiliation: The Ottawa Hospital, Civic Campus, Room B311, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada.
authors.forename: G L
authors.initials: GL
authors.lastname: Bryson
authors.affiliation: University of Ottawa, 1st Floor Administrative Services Building, The Ottawa Hospital, 1053 Carling Ave, Ottawa ON, K1Y 4E9, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Van Walraven
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000401:mortality; D019645:Arthroplasty, Replacement, Knee / Q000401:mortality; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D017048:Health Care Costs; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009864:Ontario / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D012307:Risk Factors
keywords: Arthroplasty; Frailty; Geriatrics; Health economics; Mortality