title: Comparison of Frailty Measures as Predictors of Outcomes After Orthopedic Surgery.
abstract: To apply the Frailty Phenotype (FP) and Frailty Index (FI) before major elective orthopedic surgery to categorize frailty status and assess associations with postoperative outcomes.
  
  
  
  Prospective cohort study.
  
  
  
  Two tertiary hospitals in Boston, Massachusetts.
  
  
  
  Individuals aged 70 and older undergoing scheduled orthopedic surgery enrolled in the Successful Aging after Elective Surgery (SAGES) Study (N = 415).
  
  
  
  Preoperative evaluation included assessment of frailty using the FP and FI. The weighted kappa statistic was used to determine concordance between the two frailty measures and multivariable modeling to determine associations between each measure and postoperative complications, postoperative length of stay (LOS) of longer than 5 days, discharge to postacute institutional care (PAC), and 300 day readmission.
  
  
  
  Frailty was highly prevalent (FP, 35%; FI, 41%). There was moderate concordance between the FP and FI (κ = 0.42, 95% confidence interval (CI) 0.36-0.49). When using the FP, being prefrail predicted greater risk of complications (relative risk (RR) = 1.6, 95% CI = 1.1-2.1) and discharge to PAC (RR = 1.8, 95% CI = 1.2-2.9) than being robust, and being frail predicted more complications (RR = 1.7, 95% CI = 1.1-2.1), LOS longer than 5 days (RR = 3.1, 95% CI = 1.1-8.8), and discharge to PAC (RR = 2.3 95% CI = 1.4-3.7). When using FI, being prefrail predicted LOS longer than 5 days (RR = 2.1, 95% CI = 1.0-4.8) and discharge to PAC (RR = 1.5, 95% CI = 1.4-2.1), as did being frail (RR = 1.9, 95% CI = 1.4-2.5; RR = 3.1, 95% CI = 1.4-6.8, respectively). The other outcomes were not significantly associated with frailty status.
  
  
  
  FP and FI predict postoperative outcomes after major elective orthopedic surgery and should be considered for preoperative risk stratification.
authors: Brigham and Women's Hospital, Boston, MA.
authors: Zara
authors: Z
authors: Cooper
authors: University of Texas Medical Branch, Galveston, TX.
authors: Selwyn O
authors: SO
authors: Rogers
authors: Beth Israel Deaconess Medical Center, Boston, MA.
authors: Long
authors: L
authors: Ngo
authors: Beth Israel Deaconess Medical Center, Boston, MA.
authors: Jamey
authors: J
authors: Guess
authors: Institute for Aging Research Hebrew SeniorLife, Boston, MA.
authors: Eva
authors: E
authors: Schmitt
authors: Brown University, Providence, RI.
authors: Richard N
authors: RN
authors: Jones
authors: Tufts University School of Medicine, Boston, MA.
authors: Douglas K
authors: DK
authors: Ayres
authors: Johns Hopkins School of Medicine, Boston, MA.
authors: Jeremy D
authors: JD
authors: Walston
authors: Yale School of Medicine, New Haven, CT.
authors: Thomas M
authors: TM
authors: Gill
authors: Brigham and Women's Hospital, Boston, MA.
authors: Lauren J
authors: LJ
authors: Gleason
authors: Institute for Aging Research Hebrew SeniorLife, Boston, MA.
authors: Sharon K
authors: SK
authors: Inouye
authors: Beth Israel Deaconess Medical Center, Boston, MA.
authors: Edward R
authors: ER
authors: Marcantonio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001900:Boston / Q000453:epidemiology; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D019637:Orthopedic Procedures; D010359:Patient Readmission / Q000706:statistics & numerical data; D010641:Phenotype; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D019467:Subacute Care; D016896:Treatment Outcome
keywords: elderly; frailty measures; orthopedic procedures; preoperative evaluation; surgery outcomes