Evaluation of screening tools to predict post-operative outcomes and complications in orthopaedic inpatients
Aims
The ability to predict outcomes and complications in patients undergoing surgery assists with informed consent and planning. The objective of this study was to compare the utility of screening tools in patients undergoing orthopaedic surgery .
Methods
A retrospective cohort study of 47 patients across a three-week period was performed comparing emergency hip fracture patients and patients undergoing elective total hip or knee replacements.
The tools assessed include the Rockwood Clinical Frailty Scale (CFS), the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (NSQIP) and the Charlson Comorbidity Index (CCI).
Logistic regression models were used to calculate the degree of association between the screening tools and primary outcomes of the study, which were post-operative complications and in-hospital mortality.
Results
Across the cohort, the NSQIP showed the highest degree of association (Table 1), followed by the CFS and CCI. However, the NSQIP was also the most time-consuming tool to complete (Table 2), with the CFS being the most efficient .
Table 1. Degree of association between screening tools and post-operative outcomes
Screening Tool Post-operative complications In-hospital mortality
NSQIP 10.00 13.64
CFS 0.58 2.25
CCI 0.42 0.40
Table 2. Average time taken to complete
Screening Tool Average time taken to complete (seconds)
NSQIP 157
CFS 26
CCI 52
Conclusion
The study demonstrates that the NSQIP is the best predictor of post-operative outcomes . This may be best used in preadmission clinics . The CFS is fairly predictive and efficient to use, allowing it to be easily incorporated into clinical practice in various settings. The CCI was found to be only moderately predictive despite being a valuable and easy-to-use decision-making aid with rapid prognostication capabilities.