THE IMPACT OF GERIATRIC ASSESSMENT ON DECISION-MAKING IN FRAIL ORTHOGERIATRIC PATIENTS: A PROSPECTIVE COHORT STUDY

Aim Due to population ageing and the high proportion of arthroplasty procedures among individuals aged 80 and older (38% of all arthroplasty patients), a multidisciplinary approach in orthopedic care is essential. A comprehensive geriatric assessment (CGA) serves multiple purposes: (1) preoperative optimization, (2) assistance in making definitive treatment decisions, and (3) postoperative co-management by geriatricians. This study investigated the impact of CGA on orthopedic decision-making processes in elderly patients. Method In this prospective cohort study in a tertiary referral centre, all patients aged over 70 and considered potentially frail underwent a CGA. The chosen orthopaedic treatment strategy (operative vs. conservative) and any changes relative to the initial plan were recorded. Of the 87 patients, 48.3% had a periprosthetic infection, 27.6% had osteoarthritis, 17.2% experienced aseptic loosening, and 6.9% sustained a (periprosthetic) fracture. Results 87 patients were included in the study (mean age 79 years; 57% female). Comprehensive geriatric assessment influenced treatment in 25.3% of all patients. Within the initially planned surgical group (n=80), 16 patients (18.6%) ultimately received conservative management, while two patients of the planned conservative cohort proceeded to surgery following the CGA. Frailty was common, with 14 of 27 conservatively managed patients (51.9 %) and 22 of 54 surgically treated patients (40.7 %) classified as frail. Among patients who underwent surgery (n=56), complications occurred in 70% (including acute renal insufficiency in 32% and delirium in 25%). The median duration of the hospital stay was 7 days. Geriatricians were involved in postoperative co-management for 72.6% of surgical patients. Conclusions Comprehensive geriatric assessment substantially influences the final treatment plan in orthogeriatric patients. CGA should become a standard component of diagnostic and perioperative care for elderly patients, especially when demanding treatment such as prosthetic joint infection revision are considered. Given the growing elderly population with prosthetic implants and the high rate of complications in these patients, further research is needed to evaluate the long-term impact of CGA on treatment outcomes.