The Utility of the Charlson Comorbidity Index and Modified Frailty Index as Quality Indicators in Total Joint Arthroplasty

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Total joint arthroplasty continues to burden the United States healthcare system as the population ages. Efforts to reduce costs have focused on quality measures following joint arthroplasty procedures. The purpose of this study was to investigate the effect of the Charlson Comorbidity Index (CCI) and modified Frailty Index (mFI) on length of stay (LOS), 90-day return to the operating room, 30-day readmission rates, and emergency department (ED) visits within 30 days of a joint arthroplasty procedure at a Veterans Affairs (VA) Hospital.


A retrospective chart review was conducted of patients undergoing total hip or knee arthroplasty between January 2, 2013 and March 1, 2018 (n=451). Postoperative outcomes were evaluated and compared to preoperative calculated CCI and mFI values. Binomial logistic regression was used to determine the effects of CCI and mFI on each of these outcome measures. Odds ratios (OR) were calculated for significant effects (ie, where P≤0.05).


Higher CCI was associated with LOS greater than one day (odds ration [OR]=1.25) and greater probability of readmission within 30 days (OR=1.4). Higher mFI was related to higher probability of postoperative ED visit (OR=4.95) and readmission rate (OR=10.75).


Presurgical evaluation utilizing CCI and MFI may better identify those at risk and encourage modified preoperative counseling for these patients. Further study is needed to determine a risk stratification scheme that allows for more accurate prediction of patients who may require more intense hospital-based postoperative care.

Level of Evidence:

Level IV.



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