Age-Adjusted Modified Frailty Index Predicts 30-Day Complications and Mortality in Aseptic Revision Total Hip and Knee Arthroplasty

Is Supplemented Spetzler-Martin grading Superior? A comparative study in AVM microsurgery risk stratification

The Spetzler-Martin (SM) grading system remains the most widely adopted classification for brain arteriovenous malformations (AVMs). The Supplemented Spetzler-Martin (Supp-SM) system was developed to improve surgical risk stratification by incorporating patient age, rupture status, and nidus diffuseness. However, data comparing its predictive validity remain limited. This study investigates the predictive relevance of SM and Supp-SM grading for postoperative neurological morbidity following AVM microsurgery at a single tertiary cerebrovascular centre. A retrospective review identified 96 patients who underwent AVM microsurgical resection, with or without preoperative embolisation, between 2015 and 2024. Postoperative morbidity was defined as worsened modified Rankin Scale (mRS) score at 90 days. Predictive accuracy was analysed using ROC curves, correlation with postoperative mRS scores, and Supp-SM risk threshold. Postoperative morbidity occurred in 9 patients (9.4 %). ROC analysis revealed no significant difference between SM (AUROC 0.717; 95 % CI 0.55-0.88) and Supp-SM (AUROC 0.667; 95 % CI 0.46-0.88) scores, p = 0.3899. However, Supp-SM scores demonstrated a stronger correlation with postoperative mRS changes (Spearman's ρ = 0.269, p = 0.008) than SM grades (Spearman's ρ = 0.144, p = 0.161). Patients with Supp-SM grades < 6 had a 3.2 % morbidity risk, compared with a 20.6 % risk for scores ≥ 6 (p = 0.009). A Supp-SM threshold of 6 demonstrated the highest discriminative accuracy in differentiating high- and low-risk surgical candidates. While no significant predictive difference was found between SM and Supp-SM grading, a Supp-SM score of ≥ 6 was associated with substantially higher morbidity. These findings support the adjunctive use of Supp-SM grading for surgical risk assessment in AVM patients.

Is the Effect of Chronological Age on Postoperative Complications Related to Comorbidity Burden? A Population Study of Revision Total Knee Arthroplasty Patients

BACKGROUND

The number of revision total knee arthroplasty (TKA) procedures continues to rise. Both advanced chronological age and comorbidity burden are associated with poor surgical outcomes. However, the question remains whether these two factors have a synergistic effect. Does a patient with advanced age and notable comorbidity burden carry an exponentially increased risk of complications after revision TKA? This study aims to investigate the effect of chronological age on various Charlson-Deyo Comorbidity Index (CDI) categories among revision TKA patients.

METHODS

A total of 144,402 patients who underwent elective revision TKA between 2006 and 2022 were identified from the Premier Healthcare Database. The primary outcome was the effect of chronological age on surgical outcomes following revision TKA, while stratified by the CDI. The analyzed postoperative complications in this study included postoperative cardiac complications, pneumonia, acute kidney injury, infections, central nervous system complications, and intensive care unit admissions. Spearman rank correlation coefficients and logistic regression models were used for analysis. Age was evaluated as both a continuous variable and categorical variable (<80 years versus 80+ years).

RESULTS

Both CDI and chronological age were associated with worse outcomes, with odds ratio (OR) 1.358 to 1.829 and OR 1.015 to 1.070, respectively, across these outcomes of interest. Patients aged 80 years and older had a markedly higher risk of postoperative complications across all CDI categories (OR 1.698 to 3.695) compared with patients younger than 80 years of age. The effect of chronological age on surgical outcomes does not vary under different CDI categories as chronological age presented similar patterns of OR trends on complications.

CONCLUSION

Chronological age and CDI were independent risk factors for postoperative complications in patients after revision TKA. Chronological age and CDI did not exhibit a synergistic effect on outcomes after revision TKA as the trends of impact from chronological age on outcome remained similar across different CDI categories.

A modified frailty index predicts complication, readmission, and 30-day mortality following the revision total hip arthroplasty

INTRODUCTION

This study aimed to develop a modified frailty index (MFI) to predict the risks of revision total hip arthroplasty (THA).

METHODS

Data from the American College of Surgeons - National Surgical Quality Improvement Program were analyzed for patients who underwent revision THA from 2015 to 2020. An MFI was composed of the risk factors, including severe obesity (body mass index > 35), osteoporosis, non-independent function status prior to surgery, congestive heart failure within 30 days of surgery, hypoalbuminemia (serum albumin < 3.5), hypertension requiring medication, type 1 or type 2 diabetes, and a history of chronic obstructive pulmonary disease or pneumonia. The patients were assigned based on the MFI scores (MFI0, no risk factor; MFI1, 1-2 risk factors; MFI2, 3-4 risk factors; and MFI3, 5+ risk factors). Confidence intervals were set at 95% with a P value less than or equal to 0.05 considered statistically significant.

RESULTS

A total of 17,868 patients (45% male, 55% female) were included and had an average age of 68.5 ± 11.5 years. Odds of any complication, when compared to MFI0, were 1.4 (95% CI [1.3, 1.6]) times greater for MFI1, 3.2 (95% CI [2.8, 3.6]) times greater for MFI2, and 10.8 (95% CI [5.8, 20.0]) times greater for MFI3 (P < 0.001). Odds of readmission, when compared to MFI0, were 1.4 (95% CI [1.3, 1.7]) times greater for MFI1, 2.5 (95% CI [2.1, 3.0]) times greater for MFI2, and 4.1 (95% CI [2.2, 7.8]) times greater for MFI3 (P < 0.001).

CONCLUSION

Increasing MFI scores correlate with increased odds of complication and readmission in patients who have undergone revision THA. This MFI may be used to predict the risks after revision THA.