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Frailty and risk in proximal aortic surgery.
J Thorac Cardiovasc Surg. 2014 Jan; 147(1):186-191.e1.JT

Abstract

OBJECTIVES

Although frailty has recently been examined in various populations as a predictor of morbidity and mortality, its effect on thoracic aortic surgery outcomes has not been studied. The objective of the present study was to evaluate the role of frailty in predicting postoperative morbidity and mortality in patients undergoing proximal aortic replacement surgery.

METHODS

A retrospective analysis of a prospectively maintained database was performed for all patients undergoing elective and nonelective proximal aortic operations (root, ascending aorta, and/or arch) at a single-referral institution from June 2005 to December 2012. A total of 581 patients underwent proximal aortic surgery, of whom 574 (98.8%) were included in the present analysis; 7 were excluded because of incomplete data. Frailty was evaluated using an index consisting of age >70 years, body mass index <18.5 kg/m(2), anemia, history of stroke, hypoalbuminemia, and total psoas volume in the bottom quartile of the population. One point was given for each criterion met to determine a frailty score of 0 to 6. Frailty was defined as a score of ≥2. Risk models for length of stay >14 days, discharge to other than home, 30-day composite major morbidity, 30-day composite major morbidity/mortality, and 30-day and 1-year mortality were calculated using multivariate regression modeling.

RESULTS

Of the 574 patients, 148 (25.7%) were defined as frail (frailty score ≥2). The unadjusted 30-day/in-hospital and long-term outcomes were significantly worse for the frail versus nonfrail patients in all but 1 of the outcomes analyzed; no difference was found in the 30-day readmission rates between the 2 groups. In the multivariate model, a frailty score of ≥2 was associated with discharge to other than home and 30-day and 1-year mortality.

CONCLUSIONS

Frailty, as defined using a 6-component frailty index, can serve as an independent predictor of discharge disposition and early and late mortality risk in patients undergoing proximal aortic surgery. These frailty markers, all of which are easily assessed preoperatively, could provide valuable information for patient counseling and risk stratification before proximal aortic replacement.

Authors+Show Affiliations

Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.Department of Radiology, Duke University Medical Center, Durham, NC.Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC. Electronic address: gchad.hughes@duke.edu.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

24183336

Citation

Ganapathi, Asvin M., et al. "Frailty and Risk in Proximal Aortic Surgery." The Journal of Thoracic and Cardiovascular Surgery, vol. 147, no. 1, 2014, pp. 186-191.e1.
Ganapathi AM, Englum BR, Hanna JM, et al. Frailty and risk in proximal aortic surgery. J Thorac Cardiovasc Surg. 2014;147(1):186-191.e1.
Ganapathi, A. M., Englum, B. R., Hanna, J. M., Schechter, M. A., Gaca, J. G., Hurwitz, L. M., & Hughes, G. C. (2014). Frailty and risk in proximal aortic surgery. The Journal of Thoracic and Cardiovascular Surgery, 147(1), 186-e1. https://doi.org/10.1016/j.jtcvs.2013.09.011
Ganapathi AM, et al. Frailty and Risk in Proximal Aortic Surgery. J Thorac Cardiovasc Surg. 2014;147(1):186-191.e1. PubMed PMID: 24183336.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frailty and risk in proximal aortic surgery. AU - Ganapathi,Asvin M, AU - Englum,Brian R, AU - Hanna,Jennifer M, AU - Schechter,Matthew A, AU - Gaca,Jeffrey G, AU - Hurwitz,Lynne M, AU - Hughes,G Chad, Y1 - 2013/10/30/ PY - 2013/06/26/received PY - 2013/08/20/revised PY - 2013/09/04/accepted PY - 2013/11/5/entrez PY - 2013/11/5/pubmed PY - 2014/2/14/medline KW - 26.1 KW - FP KW - NFP KW - STS KW - TPV KW - The Society of Thoracic Surgeons KW - frail patient KW - nonfrail patient KW - total psoas volume SP - 186 EP - 191.e1 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 147 IS - 1 N2 - OBJECTIVES: Although frailty has recently been examined in various populations as a predictor of morbidity and mortality, its effect on thoracic aortic surgery outcomes has not been studied. The objective of the present study was to evaluate the role of frailty in predicting postoperative morbidity and mortality in patients undergoing proximal aortic replacement surgery. METHODS: A retrospective analysis of a prospectively maintained database was performed for all patients undergoing elective and nonelective proximal aortic operations (root, ascending aorta, and/or arch) at a single-referral institution from June 2005 to December 2012. A total of 581 patients underwent proximal aortic surgery, of whom 574 (98.8%) were included in the present analysis; 7 were excluded because of incomplete data. Frailty was evaluated using an index consisting of age >70 years, body mass index <18.5 kg/m(2), anemia, history of stroke, hypoalbuminemia, and total psoas volume in the bottom quartile of the population. One point was given for each criterion met to determine a frailty score of 0 to 6. Frailty was defined as a score of ≥2. Risk models for length of stay >14 days, discharge to other than home, 30-day composite major morbidity, 30-day composite major morbidity/mortality, and 30-day and 1-year mortality were calculated using multivariate regression modeling. RESULTS: Of the 574 patients, 148 (25.7%) were defined as frail (frailty score ≥2). The unadjusted 30-day/in-hospital and long-term outcomes were significantly worse for the frail versus nonfrail patients in all but 1 of the outcomes analyzed; no difference was found in the 30-day readmission rates between the 2 groups. In the multivariate model, a frailty score of ≥2 was associated with discharge to other than home and 30-day and 1-year mortality. CONCLUSIONS: Frailty, as defined using a 6-component frailty index, can serve as an independent predictor of discharge disposition and early and late mortality risk in patients undergoing proximal aortic surgery. These frailty markers, all of which are easily assessed preoperatively, could provide valuable information for patient counseling and risk stratification before proximal aortic replacement. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/24183336/Frailty_and_risk_in_proximal_aortic_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(13)01083-0 DB - PRIME DP - Unbound Medicine ER -