Highlights
- •Frailty as determined by the mFI-5 increased the length of hospital stay of patients with bone and implant-associated infections after trauma and orthopedic surgery.
- •The mFI-5 cannot predict revision, re-admission but accompanies with mortality rate (1,7 times) in this specific patient category.
- •Frailty and increased risk of malnutrition are accompanied in patients with bone and implant-associated infections.
Abstract
Background
Bone and implant-associated infections are severe complications after trauma and orthopedic
surgery. The modified 5-item frailty index (mFI-5) is an easily applicable score to
predict adverse outcome after surgery. The current literature regarding mFI-5 is focused
on a period of 30-days postoperative.
Purpose
This study aims to assess the impact of frailty in orthopedic trauma patients with
bone and implant-associated infections. mFI-5 was calculated from a database, which
prospectively collects data about factors potentially correlated with peri- and postoperative
complications since 2014.
Methods
In a level I trauma center a total of 345 patients with surgical site infections were
enrolled in this study. Hereof, patients with fracture-related infections after osteosynthesis,
periprosthetic joint infections of the hip and knee and post-operative osteomyelitis
were included. Extensive medical baseline examination was performed in 2013/14, a
three-year follow-up was organized as a telephone interview. The mFI-5 score was calculated
based on the 5 factor-principle as established by Subramaniam. The nutritional status
was assessed using the Nutritional Risk Screening (NRS-2002).
Results
130 patients were included, whereof seven had died, resulting in 123 patients. A grouping
of our patients was performed in mFI-5 = 0 (n = 46; 36,4%), mFI-5 = 1 (n = 41; 33,3%) or mFI-5 ≥ 2 (n = 36; 29,3%). Sex distribution showed 69,1% male and 30,9% female patients. Frailty
did neither impact on the re-admission (p = 0,433) nor the reoperation (p = 0,327) rate in our cohort. The mortality risk nearly doubled (1,7 times) in frail
patients, but did not reach significance. In hospital stay was prolonged due to frailty
(12,1 ± 11,8; p = 0,004) compared to those with a mFI-5 = 0 (5,9 ± 5,1) or mFI-5 = 1 (6,9 ± 5,9). Frailty
goes along with a risk of malnutrition and increases with age.
Conclusion
The modified 5-item frailty index is not a suitable screening tool for predicting
revision rate, re-admission rate, and mortality in our orthopedic trauma patient population
with bone and implant-associated infections. Nevertheless, frailty is associated with
an increased risk of malnutrition and increases with age.
Keywords
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Article info
Publication history
Published online: January 25, 2023
Accepted:
January 22,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
