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Original Research

Open Access

Impact of preoperative frailty on choice of anesthesia modality and outcomes in elderly total joint replacement patients

  • Jiafeng Sun1
  • Changwei Zhang1
  • Zenghui Liu1
  • Mengmeng Cai1
  • Juanjuan Miao1
  • Xiaoping Yao1,*,

1Department of Anesthesiology, Affiliated Hospital 2 of Nantong University, 226001 Nantong, Jiangsu, China

DOI: 10.22514/sv.2024.047 Vol.20,Issue 4,April 2024 pp.106-114

Submitted: 31 January 2024 Accepted: 05 March 2024

Published: 08 April 2024

*Corresponding Author(s): Xiaoping Yao E-mail:


This study investigated the correlation between the degree of frailty and postoperative adverse outcomes after total joint arthroplasty (TJA) in patients undergoing TJA who received general anesthesia (GA) or intraspinal anesthesia (IA). The cohort comprised 660 elderly patients who underwent TJA and were assessed using the Fatigue, Resistance, Ambulation, Illness and Loss of Weight (FRAIL) scale. A total of 660 patients aged 65 years or older who underwent elective total joint arthroplasty were included in the analysis. Of them, 182 (27.58%) were identified as frail. GA was performed in 252 patients and IA in 408 patients. The type of anesthesia did not significantly affect outcomes across the Healthy, Pre-frailty and Frailty groups (p > 0.05). During the 1-year follow-up period, 78 deaths occurred: 3 in the Healthy group, 16 in the Pre-frailty group, and 59 in the Frailty group, revealing significant differences in mortality rates among these groups (p < 0.05). Multivariate logistic regression analysis indicated that frailty significantly increased the risk of 1-year postoperative mortality following total joint arthroplasty in this elderly cohort (p < 0.05). Specifically, the Frailty group exhibited a 2.674-fold higher risk of 1-year postoperative death compared to the Healthy group. Further analysis within the frail elderly population demonstrated that GA was a significant predictor of increased 1-year postoperative mortality risk (p < 0.05), with frail patients undergoing GA experiencing a 2.958-fold higher risk of death within one year post-operation compared to those receiving IA. In conclusion, the results support prioritizing IA in frail elderly patients to minimize the adverse effects of GA on long-term mortality risk.


Total joint arthroplasty; Elderly; Anesthesia; Frailty; Risk of death

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Jiafeng Sun,Changwei Zhang,Zenghui Liu,Mengmeng Cai,Juanjuan Miao,Xiaoping Yao. Impact of preoperative frailty on choice of anesthesia modality and outcomes in elderly total joint replacement patients. Signa Vitae. 2024. 20(4);106-114.


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