Modified frailty index is a useful predictor for complications following total elbow arthroplasty in all populations

This retrospective review aimed to specify whether the 5-item modified frailty index (mFI-5) is a valid measure for surgeons when assessing the likelihood of complications in patients undergoing total elbow arthroplasty (TEA).

TEA patients 50 years or older were identified from the NSQIP database from 2006 to 2019. Patients were stratified based on age to create a 50+, a 65+, and an 80-89-year-old cohort. Thirty-day outcomes assessed in this study included mortality, unplanned readmission, return to the operating room, urinary tract infection, bleeding requiring transfusion, prolonged hospital stay, and discharge to a location other than home. The mFI-5 was calculated based on the sum of the presence of five comorbidities. Bivariate and multivariate analyses compared the complication rates among mFI-5 scores.

The study included a total of 614 TEA patients aged 50 years or older. Following adjustment, patients older than 50 with mFI-5 = 1 had an increased risk of being discharged to a non-home location compared to patients with mFI-5 = 0 (odds ratio (OR) 3.27). Compared to patients with mFI-5 = 0, those with mFI-5 = 2 or greater had an increased risk of bleeding requiring transfusion (OR 5.13), prolonged hospital stay (> 5 days) (OR 5.83), and discharge to a non-home destination (OR 9.88). Relative to patients with mFI-5 = 1, those with mFI-5 = 2 or greater were more likely to have prolonged hospital stay (OR 3.07) and discharge to a non-home location (OR 3.05). Patients older than 65 and patients in the 80-89-year-old cohort with mFI-5 = 2 were also more likely to have a non-home discharge (OR 10.40 and 21.84, respectively).

Higher mFI-5 scores in patients aged 50 and older were associated with worse postoperative outcomes including non-home discharge, transfusion likelihood, and prolonged hospitalization. Similar trends were observed in both the 65 + and 80-89-year-old cohorts regarding the risk of non-home discharge, however, higher mFI-5 scores in these older groups did not have an increased likelihood of postoperative transfusion or prolonged hospital stay.