Preoperative simplified geriatric assessment in planned hip and knee arthroplasty

Key summary points 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. 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. 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. 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.