Evaluation of a tailored pathway for frail and pre frail older people awaiting elective hip or knee arthroplasty

Abstract

BackgroundOlder patients with clinical osteoarthritis are more likely to have a greater degree of physical frailty. These patients, when subject to a surgical procedure such as arthroplasty, often present with complex perioperative challenges and are more likely to experience adverse postoperative outcomes. AimThe objective of this study was to evaluate the effect of geriatrician-led comprehensive geriatric assessment (CGA) and interventions administered through a POPS (Perioperative care for Older People undergoing Surgery) Service on postoperative length of stay and complications in patients who were pre frail and frail waiting for elective hip or knee arthroplasty. MethodsThis was a retrospective observational cohort study comparing a post intervention cohort with historic controls. Patients ≥ 65 years of age who were waiting for hip or knee arthroplasty with a Clinical Frailty Scale (CFS) ≥4, were evaluated in our POPS @NALHN (Northern Adelaide Local Health Network) service between October 2018 and December 2019. Post-operative outcomes were compared with patients who underwent hip or knee arthroplasty between July 2017 and September 2018, who received usual care. ResultsFollowing multi-domain frailty assessment and interventions through the POPS Service, the average postoperative length of stay was shorter (6.0 days in the control group vs 3.6 days in the intervention group (Incidence Rate Ratio (IRR)=1.66, 95% CI: 1.35, 2.04; P= <0.0001). The control group was 2.5 times more likely to have postoperative complications than the intervention group (Odds Ratio= 2.55, 95% CI 1.17, 5.56, P = 0.018). The control group had a higher incidence of medical complications than the intervention group (IRR =2.01, 95% CI: 1.11, 3.64, P = 0.021). ConclusionProviding a geriatrician-led CGA and interventions to prefrail and frail older adults prior to elective hip or knee arthroplasty was associated with reduced acute hospital length of stay and medical complications. Frailty screening and intervention through CGA in the perioperative setting has the potential to enhance patient care.