What factors lead to adverse outcome after joint replacement surgery? A study of 1963 patients

Abstract

Introduction: With the ageing population, it is important that orthopaedic surgeons can accurately assess the risk of joint replacement surgery in elderly patients. This study sought to determine: (1) what factors are related to adverse outcome after joint replacement surgery and (2) to quantify the degree of frailty among such patients. Methods: All patients who had been put on waiting list for primary joint replacements in our cluster of hospitals from November 2009 till March 2020 were included. Age, sex, Charlson Comorbidity Index (CCI) and Frailty Index Lab (FI Lab) was recorded. Length of stay (LOS), 30 and 90- day mortality and 28-day emergency readmission were recorded. Results: 1963 patients were analysed. 30- and 90- day mortality was 0.2% and 0.3% respectively. Incidence of 28-day emergency readmission was 4%. Median FI Lab and CCI were 0.22 (0-0.53) and 0 (0-9) respectively. A significant association was found between age >80 years and 30- and 90- day mortality and 28-day emergency readmission (p<0.05, p<0.05 and p=0.047 respectively). Age on list was higher in those with 30- and 90-day mortality (mean 80 vs 68, p=0.029 and median 80.3 vs 68, p=0.002 respectively) compared to those that survived. CCI was higher in those with 90-day mortality (median 1 vs 0, p=0.009). LOS was positively, significantly related to age (p<0.05), CCI (p<0.05) and FI lab (p<0.05). Discussion and Conclusion: Increasing age was a significant factor predisposing to all adverse outcomes examined. Measures to optimise medical comorbidities and frailty in the elderly people are of paramount importance.