Comparative performance of the risk analysis index versus traditional frailty measures in predicting outcomes following revision total hip arthroplasty for mechanical prosthetic complications.
Jul 2026· HIP International· pp.
11207000261458685
· 0 citations· 14 references
Medicine
TL;DR
The Risk Analysis Index significantly outperforms the mFI-5 across key outcomes following revision total hip arthroplasty for mechanical prosthetic complications, making it a superior tool for surgical risk stratification, discharge planning, and identifying high-risk patients who may benefit from targeted perioperative optimisation.
Abstract
Background
Frailty assessment has become increasingly important in predicting surgical outcomes, particularly in complex revision procedures. Among patients undergoing revision total hip arthroplasty (rTHA) for mechanical prosthetic complications, optimal frailty stratification remains poorly defined. This study compared the Risk Analysis Index (RAI) and the modified 5-item frailty index (mFI-5) in predicting postoperative outcomes within this high-risk population.
Methods
We conducted a retrospective cohort study of 5631 adult patients undergoing rTHA for mechanical prosthetic complications using data from the 2015-2021 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Frailty was assessed using RAI and mFI-5, calculated via published algorithms. Primary outcomes were 30-day all-cause mortality and non-home discharge. Secondary outcomes included major complications, minor complications, unplanned readmission, reoperation, and extended length of stay (LOS >4 days). Discriminative performance was evaluated using receiver operating characteristic curves and area under the curve (AUC) analysis, with bootstrap resampling (100 iterations) for internal validation.
Results
Mean patient age was 66.80 ± 11.57 years with 57.61% female. Overall, 30-day mortality was 0.4% with major complications occurring in 2.4%. RAI demonstrated superior discrimination for mortality (AUC 0.822) compared to mFI-5 (0.688, p < 0.001). For non-home discharge, RAI achieved AUC 0.735 versus mFI-5 0.607 (p < 0.001). RAI showed strong performance for extended length of stay (AUC 0.624) and minor complications (AUC 0.652), significantly outperforming mFI-5 across multiple outcome measures.
Conclusion
The Risk Analysis Index significantly outperforms the mFI-5 across key outcomes following revision total hip arthroplasty for mechanical prosthetic complications. Its multidomain structure, which captures age, functional dependence, comorbidities, and acute physiological stress, makes it a superior tool for surgical risk stratification, discharge planning, and identifying high-risk patients who may benefit from targeted perioperative optimisation.
With an aging United States population, the incidence of perioperative complications following orthopedic procedures, including surgical management of olecranon fractures, is increasing. These complications affect not only patient outcomes but also discharge disposition. Identifying risk factors for non-routine hospital discharge, including frailty, is critical for optimizing postoperative care and discharge planning in the elderly. We hypothesized that increasing frailty as measured by the modified five-factor frailty index (mFI-5) would be independently associated with non-routine discharge following surgical fixation of olecranon fractures.
The National Inpatient Sample (NIS) was analyzed (2015-2019), focusing on elderly patients (aged ≥ 65 years) with displaced olecranon fractures who underwent surgical fixation. Patients were categorized by frailty status using the modified five-factor frailty index (mFI-5). Adverse hospitalization events and discharge status were compared.
A total of 5185 patients undergoing surgical intervention for displaced olecranon fractures were included in the study. As rated by the mFI-5, 1125 (21.7%) were non-frail, 2565 (49.5%) were prefrail, 1175 (22.7%) were frail, and 320 (6.2%) were severely frail. Age greater than 80 years was an independent risk factor for non-routine discharge [OR: 2.989 (2.640-3.386),
P
< 0.001]. Prefrail, frail, and severely frail patients had a significantly increased likelihood of non-routine discharge [OR: 1.422,
P
< 0.001; OR: 1.857,
P
< 0.001; and OR: 1.478,
P
= 0.010, respectively]. Female sex was also an independent predictor [OR: 1.340 (1.158-1.551),
P
< 0.001].
Frailty, age, and female sex are significant predictors of non-routine discharge in elderly inpatients undergoing surgical fixation for displaced olecranon fractures. These findings highlight the importance of incorporating frailty assessments into both preoperative surgical decision-making and postoperative discharge planning to improve care transitions and outcomes.
Davis Hedbany, Victor Koltenyuk, Matthew Merckling et al.· Montefiore Einstein Journal...· 0 citations
Objective
To evaluate the value of frailty in predicting postoperative complications and mortality in patients undergoing total knee arthroplasty (TKA).
Methodology
PubMed, Scopus, EMBASE and CENTRAL databases were screened up to 20th November 2025 for observational and randomized studies evaluating postoperative outcomes in frail TKA patients. Data on postoperative complications, readmission and reoperation rates, length of hospital stay and mortality were extracted. A random-effects model was used to calculate pooled risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (CIs).
Results
Sixteen studies with over 14 million patients were included. Frail patients had a significantly higher risk of 30-day mortality with RR 4.40 (95% CI: 2.18-8.91; p < 0.00001); overall postoperative complications with RR 1.85 (95% CI: 1.35-2.52; p= 0.0001); 30-day readmission with RR: 2.24 (95% CI: 1.74-2.87; p < 0.00001) and 30-day reoperation with RR: 1.81 (95% CI: 1.48-2.22; p < 0.0001). Frailty was also linked to an increased risk of surgical site infections with RR 1.56 ( 95% CI: 0.86-2.83) and prolonged hospital stay with mean difference MD 0.86 days (95% CI: 0.55-1.16; p<0.00001). Individual complications, such as myocardial infarction, renal complications and pulmonary embolism, were consistently more frequent in frail patients. Heterogeneity was moderate to high in some outcomes, attributed to differences in frailty assessment tools and study designs.
Conclusion
Within the limitations, frailty is a strong, independent predictor of increased postoperative complications, mortality and prolonged hospital stays in patients undergoing TKA. Incorporating frailty assessments into preoperative evaluations can enhance risk stratification and guide interventions to improve perioperative care in this vulnerable population.Prospero Registration Number: CRD420251035972.
Bo Jin, Jianyue Wang, Yun-gen Hu et al.· Pakistan Journal of Medical...· 0 citations
BackgroundTotal Knee arthroplasty (TKA) is an effective treatment for end-stage knee osteoarthritis (KOA), but healthcare resource utilization has become an increasing concern in an aging surgical population. Hospital Frailty Risk Score (HFRS) has been associated with adverse surgical outcomes, but its impact on resource utilization after TKA remains unclear. Using a large national database, this study aims to evaluate the association between HFRS-defined frailty risk categories and healthcare resource utilization after TKA, including length of stay (LOS), total charges (TOTCHG), and non-routine discharge.MethodsData on patients undergoing TKA were extracted from the National Inpatient Sample database. Patients were categorized into an analytic cohort and a validation cohort. We used the HFRS to identify frailty: low frailty risk (HFRS < 5), intermediate frailty risk (5-15), and high frailty risk (HFRS > 15). Patient demographic, hospital characteristics, and comorbidities were assessed. Logistic regression analyses, stratified analyses, ROC curve analyses, and sensitivity analyses were performed to evaluate associations, subgroup consistency, and discriminative performance.ResultsA total of 622,574 patients undergoing TKA for primary KOA were identified. Patients were categorized into low (n = 439,343), intermediate (n = 29,637), and high (n = 223) frailty risk groups according to the HFRS. In multivariable logistic regression analyses, higher HFRS-defined frailty risk categories were independently associated with increased healthcare resource utilization and complications. Compared with patients with low frailty risk, those with intermediate and high frailty risk had significantly higher odds of prolonged LOS, increased TOTCHG, non-routine discharge, any complication, and major complications (all P < 0.001). Sensitivity analyses using a binary classification of HFRS-defined frailty yielded consistent findings.ConclusionHFRS-defined frailty risk categories are independently associated with increased healthcare resource utilization and postoperative complications after TKA. These findings support the potential utility of HFRS for preoperative risk stratification and individualized perioperative care planning.
Linjia Li, Zhihan Wang, Yuan. Wu et al.· Journal of Orthopaedic Surge...· 0 citations
Integrating serum albumin, hematocrit, BMI, spinal region, and procedure type with frailty indices enhances risk stratification and informs surgical planning, preoperative optimization, and patient counseling in this vulnerable population of patients.
A. Ghaith, Xinlan Yang, Yazan Alasadi et al.· European spine journal· 0 citations
OBJECTIVE
Frailty is a recognized risk factor for poor surgical outcomes, particularly in the elderly. This study evaluates the predictive value of the 5-item Modified Frailty Index in patients aged 70 and older undergoing head and neck cancer resection with microvascular free flap reconstruction.
STUDY DESIGN
Retrospective cohort study.
SETTING
Tertiary academic medical center.
METHODS
Patients aged ≥ 70 years old who underwent oncologic resection and free flap reconstruction from 2014 to 2022 were included. Patients were stratified by 5-item Modified Frailty Index score into non-frail (0), mildly frail (1), and moderately to severely frail (≥2). Primary outcomes included 90-day mortality, 30-day complications, readmission, and return to the operating room. Multivariable logistic regression was used to control potential confounders.
RESULTS
A total of 211 patients were included. Patients with 5-item Modified Frailty Index scores ≥ 2 had significantly higher 90-day mortality compared to less frail patients (p = 0.031), and they were more frequently discharged to a facility rather than home. While not statistically significant, complication and readmission rates were higher in frail patients. Multivariable analysis showed that patients with 5-item Modified Frailty Index ≥ 2 had increased odds of experiencing complications (OR 2.44, 95 % CI 1.06-5.91)and mortality (OR 1.17, 95 % CI 0.36-4.59).
CONCLUSION
The 5-item Modified Frailty Index is a simple and clinically useful tool for identifying older head and neck cancer patients at increased risk of adverse outcomes following major surgery. Its incorporation into preoperative risk assessment may improve surgical decision-making and perioperative planning by better stratifying risk and guiding resource allocation.
John J Sykes, Edgar D Uribe Sanchez, D. Benito et al.· Oral Oncology· 1 citation
BACKGROUND
With major lower limb orthopaedic surgery performed in increasingly older and comorbid patients, accurate risk prediction is essential to guide perioperative management and shared decision-making.
AIMS
To compare the Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI) and the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (ACS NSQIP Calculator) in predicting complications following major lower limb orthopaedic surgery.
METHODS
We conducted an audit assessing the clinical utility of the CFS, CCI and ACS NSQIP Calculator at an Australian tertiary hospital (2023-2024). Scores were calculated retrospectively using admission documentation, and complications were identified prospectively.
RESULTS
We recruited 302 patients with a mean age of 75.1 ± 12.7 years. Patients underwent surgery for hip fracture (n = 100), elective total knee (n = 103) and hip (n = 69) arthroplasty and other indications (n = 30). During index hospitalisation, 27.5% (n = 83) experienced a serious complication (Clavien-Dindo Grade ≥ II). All tools demonstrated moderate discrimination for serious in-hospital complications; the CFS, CCI and ACS NSQIP Calculator had area under the receiver operating characteristic curves of 0.77 (95% confidence interval (CI) 0.71-0.83), 0.71 (95% CI 0.64-0.77) and 0.76 (95% CI 0.70-0.82) respectively. The CFS was the fastest tool to administer, and the ACS NSQIP Calculator was the most time-consuming (median time 9.5 s (interquartile range (IQR) 7-13) vs 98.5 s (IQR 73-165), P < 0.001).
CONCLUSION
The CFS and ACS NSQIP Calculator demonstrated similar predictive performance in this cohort. Given its faster administration, the CFS may represent a practical tool for routine perioperative risk stratification, though prospective validation is required to confirm performance in real-time clinical workflows.
Alexa Yao, Emily Schembri, Ejoy Zhang et al.· Internal medicine journal (P...· 0 citations