Utility of the Clinical Frailty Scale, Charlson Comorbidity Index and ACS NSQIP Surgical Risk Calculator in major lower limb orthopaedic surgery.
TL;DR
Given its faster administration, the CFS may represent a practical tool for routine perioperative risk stratification, though prospective validation is required to confirm performance in real-time clinical workflows.
Abstract
Background
With major lower limb orthopaedic surgery performed in increasingly older and comorbid patients, accurate risk prediction is essential to guide perioperative management and shared decision-making.
Aims
To compare the Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI) and the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (ACS NSQIP Calculator) in predicting complications following major lower limb orthopaedic surgery.
Methods
We conducted an audit assessing the clinical utility of the CFS, CCI and ACS NSQIP Calculator at an Australian tertiary hospital (2023-2024). Scores were calculated retrospectively using admission documentation, and complications were identified prospectively.
Results
We recruited 302 patients with a mean age of 75.1 ± 12.7 years. Patients underwent surgery for hip fracture (n = 100), elective total knee (n = 103) and hip (n = 69) arthroplasty and other indications (n = 30). During index hospitalisation, 27.5% (n = 83) experienced a serious complication (Clavien-Dindo Grade ≥ II). All tools demonstrated moderate discrimination for serious in-hospital complications; the CFS, CCI and ACS NSQIP Calculator had area under the receiver operating characteristic curves of 0.77 (95% confidence interval (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 fastest tool to administer, and the ACS NSQIP Calculator was the most time-consuming (median time 9.5 s (interquartile range (IQR) 7-13) vs 98.5 s (IQR 73-165), P < 0.001).
Conclusion
The CFS and ACS NSQIP Calculator demonstrated similar predictive performance in this cohort. Given its faster administration, the CFS may represent a practical tool for routine perioperative risk stratification, though prospective validation is required to confirm performance in real-time clinical workflows.