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The modified 5-item frailty index determines the length of hospital stay and accompanies with mortality rate in patients with bone and implant-associated infections after trauma and orthopedic surgery

  • Felix Erne
    Affiliations
    Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
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  • Vera Wallmeier
    Affiliations
    Klinik für Hals-Nasen-Ohrenkrankheiten, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
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  • Christoph Ihle
    Affiliations
    Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
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  • Benedikt J Braun
    Affiliations
    Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
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  • Sabrina Ehnert
    Affiliations
    Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
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  • Tina Histing
    Affiliations
    Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
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  • Andreas K Nüssler
    Affiliations
    Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
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  • Elke Maurer
    Correspondence
    Corresponding author.
    Affiliations
    Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
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Published:January 25, 2023DOI:https://doi.org/10.1016/j.injury.2023.01.042

      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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