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Frailty increases the risk of 30-day mortality, morbidity, and failure to rescue after elective abdominal aortic aneurysm repair independent of age and comorbidities.
J Vasc Surg. 2015 Feb; 61(2):324-31.JV

Abstract

BACKGROUND

Frailty, defined as a biologic syndrome of decreased reserve and resistance to stressors, has been linked to adverse outcomes after surgery. We evaluated the effect of frailty on 30-day mortality, morbidity, and failure to rescue (FTR) in patients undergoing elective abdominal aortic aneurysm (AAA) repair.

METHODS

Patients undergoing elective endovascular AAA repair (EVAR) or open AAA repair (OAR) were identified in the National Surgical Quality Improvement Program database for the years 2005 to 2012. Frailty was assessed using the modified frailty index (mFI) derived from the Canadian Study of Health and Aging (CSHA). The primary outcome was 30-day mortality, and secondary outcomes included 30-day morbidity and FTR. The effect of frailty on outcomes was assessed by multivariate regression analysis, adjusted for age, American Society of Anesthesiology (ASA) class, and significant comorbidities.

RESULTS

Of 23,207 patients, 339 (1.5% overall; 1.0% EVAR and 3.0% OAR) died ≤30 days of repair. One or more complications occurred in 2567 patients (11.2% overall; 7.8% EVAR and 22.1% OAR). Odds ratios (ORs) for mortality adjusted for age, ASA class, and other comorbidities in the group with the highest frailty score were 1.9 (95% confidence interval [CI], 1.2-3.0) after EVAR and 2.3 (95% CI, 1.4-3.7) after OAR. Similarly, compared with the least frail, the most frail patients were significantly more likely to experience severe (Clavien-Dindo class IV) complications after EVAR (OR, 1.7; 95% CI, 1.3-2.1) and OAR (OR, 1.8; 95%, CI, 1.5-2.1). There was also a higher FTR rate among frail patients, with 1.7-fold higher risk odds of mortality (95% CI, 1.2-2.5) in the highest tertile of frailty compared with the lowest when postoperative complications occurred.

CONCLUSIONS

Higher mFI, independent of other risk factors, is associated with higher mortality and morbidity in patients undergoing elective EVAR and OAR. The mortality in frail patients is further driven by FTR from postoperative complications. Preoperative recognition of frailty may serve as a useful adjunct for risk assessment.

Authors+Show Affiliations

Division of Vascular Surgery, Emory University School of Medicine, Atlanta, Ga; Atlanta Veterans Affairs Medical Center, Decatur, Ga. Electronic address: shipra.arya@emory.edu.Emory University Rollins School of Public Health, Atlanta, Ga.Division of Vascular Surgery, Emory University School of Medicine, Atlanta, Ga.Division of Vascular Surgery, Emory University School of Medicine, Atlanta, Ga; Atlanta Veterans Affairs Medical Center, Decatur, Ga.Division of Vascular Surgery, Emory University School of Medicine, Atlanta, Ga.Division of Vascular Surgery, Emory University School of Medicine, Atlanta, Ga; Atlanta Veterans Affairs Medical Center, Decatur, Ga.Division of Vascular Surgery, Emory University School of Medicine, Atlanta, Ga.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25312534

Citation

Arya, Shipra, et al. "Frailty Increases the Risk of 30-day Mortality, Morbidity, and Failure to Rescue After Elective Abdominal Aortic Aneurysm Repair Independent of Age and Comorbidities." Journal of Vascular Surgery, vol. 61, no. 2, 2015, pp. 324-31.
Arya S, Kim SI, Duwayri Y, et al. Frailty increases the risk of 30-day mortality, morbidity, and failure to rescue after elective abdominal aortic aneurysm repair independent of age and comorbidities. J Vasc Surg. 2015;61(2):324-31.
Arya, S., Kim, S. I., Duwayri, Y., Brewster, L. P., Veeraswamy, R., Salam, A., & Dodson, T. F. (2015). Frailty increases the risk of 30-day mortality, morbidity, and failure to rescue after elective abdominal aortic aneurysm repair independent of age and comorbidities. Journal of Vascular Surgery, 61(2), 324-31. https://doi.org/10.1016/j.jvs.2014.08.115
Arya S, et al. Frailty Increases the Risk of 30-day Mortality, Morbidity, and Failure to Rescue After Elective Abdominal Aortic Aneurysm Repair Independent of Age and Comorbidities. J Vasc Surg. 2015;61(2):324-31. PubMed PMID: 25312534.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frailty increases the risk of 30-day mortality, morbidity, and failure to rescue after elective abdominal aortic aneurysm repair independent of age and comorbidities. AU - Arya,Shipra, AU - Kim,Sung In, AU - Duwayri,Yazan, AU - Brewster,Luke P, AU - Veeraswamy,Ravi, AU - Salam,Atef, AU - Dodson,Thomas F, Y1 - 2014/10/12/ PY - 2014/07/28/received PY - 2014/08/28/accepted PY - 2014/10/15/entrez PY - 2014/10/15/pubmed PY - 2015/4/10/medline SP - 324 EP - 31 JF - Journal of vascular surgery JO - J Vasc Surg VL - 61 IS - 2 N2 - BACKGROUND: Frailty, defined as a biologic syndrome of decreased reserve and resistance to stressors, has been linked to adverse outcomes after surgery. We evaluated the effect of frailty on 30-day mortality, morbidity, and failure to rescue (FTR) in patients undergoing elective abdominal aortic aneurysm (AAA) repair. METHODS: Patients undergoing elective endovascular AAA repair (EVAR) or open AAA repair (OAR) were identified in the National Surgical Quality Improvement Program database for the years 2005 to 2012. Frailty was assessed using the modified frailty index (mFI) derived from the Canadian Study of Health and Aging (CSHA). The primary outcome was 30-day mortality, and secondary outcomes included 30-day morbidity and FTR. The effect of frailty on outcomes was assessed by multivariate regression analysis, adjusted for age, American Society of Anesthesiology (ASA) class, and significant comorbidities. RESULTS: Of 23,207 patients, 339 (1.5% overall; 1.0% EVAR and 3.0% OAR) died ≤30 days of repair. One or more complications occurred in 2567 patients (11.2% overall; 7.8% EVAR and 22.1% OAR). Odds ratios (ORs) for mortality adjusted for age, ASA class, and other comorbidities in the group with the highest frailty score were 1.9 (95% confidence interval [CI], 1.2-3.0) after EVAR and 2.3 (95% CI, 1.4-3.7) after OAR. Similarly, compared with the least frail, the most frail patients were significantly more likely to experience severe (Clavien-Dindo class IV) complications after EVAR (OR, 1.7; 95% CI, 1.3-2.1) and OAR (OR, 1.8; 95%, CI, 1.5-2.1). There was also a higher FTR rate among frail patients, with 1.7-fold higher risk odds of mortality (95% CI, 1.2-2.5) in the highest tertile of frailty compared with the lowest when postoperative complications occurred. CONCLUSIONS: Higher mFI, independent of other risk factors, is associated with higher mortality and morbidity in patients undergoing elective EVAR and OAR. The mortality in frail patients is further driven by FTR from postoperative complications. Preoperative recognition of frailty may serve as a useful adjunct for risk assessment. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/25312534/Frailty_increases_the_risk_of_30_day_mortality_morbidity_and_failure_to_rescue_after_elective_abdominal_aortic_aneurysm_repair_independent_of_age_and_comorbidities_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(14)01699-1 DB - PRIME DP - Unbound Medicine ER -