Prevalence of pre-frailty and frailty and their association with postoperative hospital days in older adults referred for elective orthopaedic surgery

The aim of this study was to investigate the prevalence of pre-frailty and frailty among older persons referred for elective orthopaedic surgery and determine whether frailty was associated with the occurrence of postoperative complications, measured as the number of days spent in the hospital within 90 days after surgery.

Between April 1 and July 31, 2022, we consecutively included individuals aged 65 years or older who were referred for elective shoulder, knee, hip, or spine surgery at a centre for elective surgery. Health status was assessed preoperatively using the record-based Multidimensional Prognostic Index, based on data extracted from the electronic medical record by a geriatrician. Postoperative hospital data were obtained from the Business Intelligence Data Warehouse of the Central Denmark Region.

A total of 519 persons were included, with a mean age of 75.2 years (SD 5.9), and 56% were females. The majority of the persons were referred for elective hip (41%) or knee (37%) arthroplasty. Preoperatively, 26% of the persons were classified as pre-frail and 4% as moderately frail, while none were severely frail. Pre-frailty and moderate frailty were associated with a greater number of hospital days within 90 days post-surgery compared with non-frail persons.

More than one in four older persons aged 65 + referred for elective orthopaedic surgery are pre-frail or moderate frail. Identifying this vulnerability is essential for optimizing care across healthcare settings and professions, with the goal of preventing postoperative complications.