Hospital Frailty Risk Score outperforms current risk stratification models in primary total hip and knee arthroplasty

Abstract Introduction Models for risk stratification and prediction of outcome, such as the Charlson Comorbidity Index (CCI), the Elixshauser Comorbidity Method (ECM), the 5-factor modified Frailty Index (mFI-5) and the Hospital Frailty Risk Score (HFRS) have been validated in orthopedic surgery. The aim of the current study was to compare the predictive power of these models in total hip and knee replacement. Methods In a retrospective analysis of 8250 patients who had undergone total joint replacement between 2011 and 2019, CCI, ECM, mFI-5 and HFRS were calculated for each patient. Receivers operating characteristic (ROC) curve plots were generated and the area under the curve (AUC) was compared between each score with regard to adverse events such as transfusion, surgical, medical and other complications. Multivariate logistic regression models were used to assess the relationship between risk stratification models, demographic factors and postoperative adverse events. Results In prediction of surgical complications, HFRS performed best (AUC:0.719,p Conclusion The HFRS is superior to current risk stratification models in the context of total joint replacement. As the HRFS derives from routinely collected administrative data, health care providers can identify at-risk patients without additional effort or expense.