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Preoperative simplified geriatric assessment in planned hip and knee arthroplasty

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Key summary points

AbstractSection Aim

The main objective of this work was to identify the criteria of a simplified standardized geriatric assessment (mini-CGA) that were associated with unplanned hospital readmission within 3 months after planned hip and/or knee arthroplasty in patients ≥ 65 years, and the secondary objective was to determine the geriatric frailties associated with postoperative complications.

AbstractSection Findings

We found that dependence assessed using the activities of daily living (ADL) scale was associated with the risk of early readmission in older patients undergoing planned arthroplasty, and that living alone prior to surgery was associated with complications during the first 3 postoperative months.

AbstractSection Message

Preoperative assessment before planned orthopedic surgical procedures using the simplified geriatric assessment (mini-CGA) appears essential to limit the risks of postoperative morbidity and to identify larger numbers of frail older patients in order to propose appropriate interventions after geriatric assessment.

Abstract

Introduction

Hip and knee arthroplasties are the most common planned orthopedic surgical procedures in older persons. It would be useful to identify frailties before surgery to improve the outcome of older patients.

Purpose

The objective of this work was to identify the criteria of a simplified comprehensive geriatric assessment (mini-CGA) that were associated with unplanned hospital readmission and postoperative complications within 3 months after the planned hip and/or knee arthroplasty in patients ≥ 65 years.

Methods

This prospective study was carried out in the orthopedic department of Marseille University Hospital from January to May 2019. A mini-CGA was performed preoperatively.

Results

One hundred four patients were included in the study. The rate of early readmission within 3 months after surgery was 12.5% and the rate of postoperative complications was 40.4%. In multivariate analysis, dependence in the activities of daily living (ADL ≤ 5) was the only factor associated with unplanned readmission (aOR = 9.9, 95% CI 1.9–50.8), and living alone was the only factor associated with postoperative complications (aOR = 3.2, 95% CI 1.2–8.8).

Conclusions

We found that the ADL score was associated with the risk of unplanned readmission in older patients undergoing planned arthroplasty, and that living alone was associated with postoperative complications. A preoperative mini-CGA appears essential to limit postoperative morbidity.

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Acknowledgements

The authors would like to thank all patients and orthopedic surgeons who agreed to participate in this work.

Funding

This study has no funding.

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Authors and Affiliations

  1. Internal Medicine, Geriatric and Therapeutic Unit, University Hospital of Marseille, AP-HM, 13009, Marseille, France

    Anne-Laure Couderc, Emilie Nouguerede, Dominique Rey & Patrick Villani

  2. Aix-Marseille University, CNRS, EFS, ADES, Marseille, France

    Anne-Laure Couderc, Loïc Lalys & Patrick Villani

  3. Infectious Diseases Unit, University Hospital of Infectiology IHU Mediterranée, AP-HM, Marseille, France

    Anais Alexandre, Auriane Baudier & Andreas Stein

  4. Public Health Department, AP-HM, Marseille, France

    Vincent Pradel

  5. Orthopedic Surgery, Institute of Movement and Locomotor System IML, AP-HM, Marseille, France

    Jean-Noël Argenson

  6. Aix-Marseille University, Marseille, France

    Jean-Noël Argenson & Andreas Stein

Authors
  1. Anne-Laure Couderc
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  2. Anais Alexandre
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  7. Jean-Noël Argenson
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  10. Patrick Villani
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Corresponding author

Correspondence to Anne-Laure Couderc.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Committee of Protection of Persons Ile de France II (Ethics committee agreement number: 2018-A02606-49, January 2019). It was carried out in conformity with the general regulations concerning data protection.

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Patients who agreed completed a consent form.

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Couderc, AL., Alexandre, A., Baudier, A. et al. Preoperative simplified geriatric assessment in planned hip and knee arthroplasty. Eur Geriatr Med 11, 623–633 (2020). https://doi.org/10.1007/s41999-020-00364-5

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  • DOI: https://doi.org/10.1007/s41999-020-00364-5

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