Background: Surgery for osteoporotic hip fractures and osteoarthritis is increasingly performed in older and multimorbid patients. Accurate risk prediction and identification of high-risk patients can guide perioperative management and shared decision-making.
Methods: We evaluated the utility of the Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI), and the American College of Surgeons’ Surgical Risk Calculator (ACS NSQIP) in predicting complications following major lower limb orthopaedic surgery at an Australian tertiary hospital in 2023–2024. Patients were recruited postoperatively and complications were prospectively identified.
Results: We recruited 302 patients with a mean age of 75.1 ± 12.7 years. Patients underwent surgery for hip fracture (n=100), total knee (n=103) and hip (n=69) arthroplasty, and periprosthetic fracture or other indications (n=30). During index hospitalisation, 27.5% (n=83) experienced a serious complication classified as Clavien-Dindo grade ≥ II. The tools demonstrated moderate discrimination for serious in-hospital complications; the CFS, CCI, and ACS NSQIP had area under the receiver operating characteristic curve values of 0.77 (95% CI 0.71–0.83), 0.71 (95% CI 0.64–0.77), and 0.76 (95% CI 0.70–0.82) respectively. The CFS was the least time-consuming to complete, and the ACS NSQIP was the most time-consuming (median time 9.5s [IQR 7–13] vs. 98.5s [IQR 73–165], p<0.001).
Conclusion: The CFS and ACS NSQIP demonstrated similar predictive performance in this cohort. Given its simplicity, the CFS may be better suited for rapidly identifying patients requiring closer perioperative monitoring in emergency surgery settings.