Predicting hospital outcomes with the reported edmonton frail scale-Thai version in orthopaedic older patients.
Inthira Roopsawang, Hilaire Thompson, Oleg Zaslavsky and 1 others
PMID 32981142WHAT IT FOUND
Preoperative frailty screening with the REFS-Thai predicted postoperative complications and delirium better than standard medical assessments in older orthopaedic patients.
Frail patients had higher odds of complications and longer stays, while apparent frailty also predicted delirium.
Key findings
01Frail patients were 2.38 times more likely to develop postoperative complications and had a 1.42 times higher relative risk of prolonged length of stay compared to nonfrail patients after adjusting for age, gender, surgery type, and comorbidity.
02Both frail and apparent frailty groups were significantly more likely to experience postoperative delirium compared to the nonfrail group.
03The REFS-Thai tool showed good predictive performance for postoperative delirium (AUC 0.81) and complications (AUC 0.81), performing on par with or better than standard ASA and Elixhauser Comorbidity measures.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPsWhat it means for RNs
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What it does not show
Single-centre study at a university hospital in Thailand, limiting generalisability to other regions or rural settings. Participants were scheduled for elective surgery and excluded if they had pre-existing cognitive impairment, so findings may not apply to emergency surgical patients or those with dementia. The study did not measure biological markers of frailty (e.g., grip strength, inflammation levels), relying solely on self-report and clinical assessment. Small number of patients discharged to facilities other than home (11%) may have reduced the power to detect associations with discharge disposition.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume the REFS-Thai is superior to all standard assessments for every outcome; for length of stay, the Elixhauser Comorbidity Measure (EMC) had the best predictive ability. Also, the lack of association with discharge disposition may be due to the small number of patients transferred to other facilities, so do not use frailty scores alone to predict whether a patient will go home.