Modified frailty index (mFI): is it a predictor for early postoperative complications in arthroplasty surgery?

OBJECTIVE: It has been demonstrated that the modified frailty index (mFI) is a powerful and effective tool in the prediction of perioperative risk in many surgical fields. In many previous studies, mFI has been found to be successful in prediction of perioperative adverse effects. The aim of this study was to determine whether the mFI can be a predictor for early postoperative complications in arthroplasty surgery. PATIENTS AND METHODS: 145 patients aged 45-85 undergoing primary or revision total knee and hip arthroplasty were included in this prospective study. mFI was calculated in all patients, and patients included in the current study were grouped as "Frail" (n=42) and "Nonfrail" (n=103) patients according to modified frailty index values. Postoperative complications (myocardial infarction, cardiac arrest, pulmonary embolism, septic shock, postoperative dialysis requirement, cerebrovascular event, reintubation, prolonged mechanical ventilation, surgical wound complications), duration of hospitalization, requirement for intensive care unit (ICU) admission and rehospitalization and 30-day mortality were recorded and the correlation between mFI and these parameters were evaluated. RESULTS: The mean age was 67.58±9.35 years, and 72.4% of the patients were female. The percentage of frail patients in the current study was 28.9%. The percentage of ASA-1, ASA-2, and ASA-3 patients was 17.2%, 57.2%, and 25.5%, respectively. The rate of ICU admission, MI, septic shock, postoperative dialysis requirement, prolonged MV requirement, hospital readmission, and 30-day mortality were 45.2%, 14.3%, 16.7%, 16.7%, 14.3%, 11.9%, and 16.7%, respectively in the frail group and were 7.8%, 1%, 1.9%, 2.9, 1.9% and 3.9%, respectively in the nonfrail group. Advanced age, male gender, high ASA score and prolonged duration of surgery were found to be predictive factors for postoperative complications. Advanced age, high ASA score and prolonged duration of surgery were found to be predictive factors for ICU admission. Advanced age, male gender and high ASA score were found to be strong predictors of 30-day mortality. CONCLUSIONS: mFI was found to be a strong predictor for postoperative complications and mortality. It is an easy, reliable, and simple method to evaluate frailty during the preoperative period. CLINICAL TRIAL REGISTRATION NUMBER: NCT05424575.

Comparison of C-MAC vs. McGrath video laryngoscopes on glottic exposure and endotracheal intubation success with stylet usage in obese patients.

OBJECTIVE: Cases of obesity are rising in parallel with the number of obese patients scheduled for anesthesia in which difficult airway is encountered. Video laryngoscopes (VL) have emerged as a popular device for the management of patients with difficult airway. The present study compares the success rate of intubation in obese patients using stylet in the ramped position using either a McGrath or C-MAC VLs. PATIENTS AND METHODS: Class II/III obese patients who were intubated with either McGrath (Group M, n=50) or C-MAC (Group C, n=50) laryngoscopes were assessed for the presence of difficult airway using the Difficult Airway Assessment tool, the Airway Difficulty Score and the Total Airway Score. The intubation attempts were made after the best glottic view, direct and indirect Cormack-Lehane (CL) score, and intubation time were recorded. In the event of failure, a further intubation attempt was made using a styled, and the intubation time was again recorded. If the intubation failed again, a third attempt was made using a C-MAC D-Blade. The Intubation Difficulty Scale score was recorded after the intubation. RESULTS: There was no statistically significant difference between groups in terms of demographic data, the number of patients with decreased CL score, the number of attempts required for intubation, or the first and second intubation time. The ADS Score, TAS Score, CL Score DL, and CL Score IN were found to be important risk factors for a second intubation requirement, and the cut-off value was found to be 8.50 for the ADS Score and 4.50 for the TAS Score in these patients. In the 38 patients who required a second intubation attempt, the procedure was successful in all, but one patient required a third attempt of intubation with C-MAC D-blade. CONCLUSIONS: Both McGrath and C-MAC were effective and comparable for best glottic view with no failed intubation. It was concluded that regardless of the type of video laryngoscope used, the use of a stylet in the first intubation attempt increases the success of intubation.