{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T14:31:54Z","timestamp":1786545114894,"version":"build-2736575974"},"reference-count":43,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n With major lower limb orthopaedic surgery performed in increasingly older and comorbid patients, accurate risk prediction is essential to guide perioperative management and shared decision\u2010making.<\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n To compare the Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI) and the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (ACS NSQIP Calculator) in predicting complications following major lower limb orthopaedic surgery.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted an audit assessing the clinical utility of the CFS, CCI and ACS NSQIP Calculator at an Australian tertiary hospital (2023\u20132024). Scores were calculated retrospectively using admission documentation, and complications were identified prospectively.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We recruited 302 patients with a mean age of 75.1 \u00b1\u200912.7\u2009years. Patients underwent surgery for hip fracture (\n n<\/jats:italic>\n =\u2009100), elective total knee (\n n<\/jats:italic>\n =\u2009103) and hip (\n n<\/jats:italic>\n =\u200969) arthroplasty and other indications (\n n<\/jats:italic>\n =\u200930). During index hospitalisation, 27.5% (\n n<\/jats:italic>\n =\u200983) experienced a serious complication (Clavien\u2010Dindo Grade \u2265 II). All tools demonstrated moderate discrimination for serious in\u2010hospital complications; the CFS, CCI and ACS NSQIP Calculator had area under the receiver operating characteristic curves of 0.77 (95% confidence interval (CI) 0.71\u20130.83), 0.71 (95% CI 0.64\u20130.77) and 0.76 (95% CI 0.70\u20130.82) respectively. The CFS was the fastest tool to administer, and the ACS NSQIP Calculator was the most time\u2010consuming (median time 9.5 s (interquartile range (IQR) 7\u201313) vs 98.5 s (IQR 73\u2013165),\n P<\/jats:italic>\n <\u20090.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The CFS and ACS NSQIP Calculator demonstrated similar predictive performance in this cohort. Given its faster administration, the CFS may represent a practical tool for routine perioperative risk stratification, though prospective validation is required to confirm performance in real\u2010time clinical workflows.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/imj.70598","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T13:36:28Z","timestamp":1786541788000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Utility of the Clinical Frailty Scale, Charlson Comorbidity Index and\n ACS<\/scp>\n NSQIP<\/scp>\n Surgical Risk Calculator in major lower limb orthopaedic surgery"],"prefix":"10.1111","author":[{"given":"Alexa","family":"Yao","sequence":"first","affiliation":[{"name":"Eastern Health Clinical School Monash University Faculty of Medicine, Nursing, and Health Sciences Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Schembri","sequence":"additional","affiliation":[{"name":"Eastern Health Clinical School Monash University Faculty of Medicine, Nursing, and Health Sciences Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ejoy","family":"Zhang","sequence":"additional","affiliation":[{"name":"Eastern Health Clinical School Monash University Faculty of Medicine, Nursing, and Health Sciences Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Hau","sequence":"additional","affiliation":[{"name":"Eastern Health Clinical School Monash University Faculty of Medicine, Nursing, and Health Sciences Melbourne Victoria Australia"},{"name":"Department of Orthopaedic Surgery Eastern Health Melbourne Victoria 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