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.

Peritonsillar infiltration with levobupivacaine for posttonsillectomy pain relief: does concentration have any effect? A double-blind randomized controlled clinical study.

OBJECTIVE: Post-tonsillectomy pain is believed to be mediated by noxious stimulation of C-fiber afferents located in the peritonsillary space, and local anesthetic infiltration to this area may decrease pain by blocking the sensory pathways and thus preventing the nociceptive impulses. We aimed to compare the effects of different concentrations of preincisional peritonsillar levobupivacaine (0.25% and 0.5%) infiltration on postoperative pain and bleeding in a placebo-controlled design. PATIENTS AND METHODS: After obtaining Institutional Ethics Committee approval, 72 ASA I-II patients between 3 and 12 years of age, scheduled to undergo tonsillectomy were enrolled and randomly assigned to one of the three groups using the sealed envelope technique, as Group I (Control group), Group II, and Group III receiving preincisional bilateral peritonsillar infiltration with saline, 0.25% levobupivacaine and 0.5% levobupivacaine, respectively (3 mL to each tonsil). Pain, fever, dysphagia; nausea-vomiting and hemorrhage were evaluated at postoperative 0, 30, and 60 minutes and 2, 6, 12, and 24 hours. Oral paracetamol was administered at a dose of 15 mg/kg when FLACC score was > 4. The number of paracetamol administrations within the first 24 hours were recorded. RESULTS: The patients in Groups I, II and III defined pain (FLACC > 4) at a rate of 87%, 60.9%, and 54.2% within the postoperative first 24 hours, respectively. The total number of additional analgesic requirements was significantly low in Group II and III when compared with Group I. There was no difference between groups in terms of fever, dysphagia, nausea-vomiting, hemorrhage. CONCLUSIONS: Both concentrations (0.50% and 0.25%) of levobupivacaine were found to be equally safe and effective during preincisional peritonsillar infiltration in children. NCT number: 02322346.