Predicting hospital outcomes with the reported edmonton frail scale-Thai version in orthopaedic older patients

J Clin Nurs. 2020 Dec;29(23-24):4708-4719. doi: 10.1111/jocn.15512. Epub 2020 Oct 11.


Aims and objectives: To test the ability of the Reported Edmonton Frail Scale-Thai version to predict hospital outcomes compared with standard preoperative assessment measures (American Society of Anesthesiologists physical status classification and the Elixhauser Comorbidity Measure) in older Thai orthopaedic patients.

Background: Frailty is a common geriatric condition. No previous studies have assessed frailty among orthopaedic patients in Thailand. Effective frailty screening could enhance quality of care.

Design: Prospective cohort study in a university hospital.

Methods: Two hundred hospitalised patients, aged 60 years or older and scheduled for orthopaedic surgery, participated in the study. Frailty was evaluated using the Reported Edmonton Frail Scale-Thai version. Multiple Firth logistic regression was used to model the effect of frailty on postoperative complications, postoperative delirium and discharge disposition. Length of stay was examined using Poisson regression. Comparing predictability of the instruments, the area under the receiver operating characteristic curve and mean squared errors were evaluated. The STROBE guideline was used.

Results: Participants' mean age was 72 years; mostly were female, frail and underwent knee, spine and/or hip surgery. Poor health outcomes including postoperative complications, postoperative delirium, and not being discharged to the home were commonly identified. The length of stay varied from three days to more than ten weeks. Frailty was significantly associated with postoperative complications, postoperative delirium and prolonged length of stay. The Reported Edmonton Frail Scale-Thai version revealed good performance for predicting postoperative complications and postoperative delirium and was improved by combining with standard assessments.

Conclusion: The Reported Edmonton Frail Scale-Thai version, alone or combined with standard assessment, was useful for predicting adverse outcomes in older adults undergoing orthopaedic surgery.

Relevance to clinical practice: These findings indicate that nurse professionals should apply culturally sensitive frailty screening to proactively identify patients' risk of frailty, improve care quality and prevent adverse outcomes.

Keywords: frail elderly; frailty; geriatric assessment; hospitals; instruments; older adults; orthopaedic surgery; patient care; postoperative complications; quality of care.

MeSH terms

  • Aged
  • Frail Elderly*
  • Geriatric Assessment
  • Hospitals
  • Humans
  • Length of Stay
  • Middle Aged
  • Orthopedics*
  • Postoperative Complications / epidemiology
  • Prospective Studies
  • Risk Factors
  • Thailand