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Preoperative frailty assessment predicts loss of independence after vascular surgery.
J Vasc Surg. 2018 11; 68(5):1382-1389.JV

Abstract

OBJECTIVE

Frailty, a clinical syndrome associated with loss of metabolic reserves, is prevalent among patients who present to vascular surgery clinics for evaluation. The Clinical Frailty Scale (CFS) is a rapid assessment method shown to be highly specific for identifying frail patients. In this study, we sought to evaluate whether the preoperative CFS score could be used to predict loss of independence after major vascular procedures.

METHODS

We identified all patients living independently at home who were prospectively assessed using the CFS before undergoing an elective major vascular surgery procedure (admitted for >24 hours) at an academic medical center between December 2015 and December 2017. Patient- and procedure-level clinical data were obtained from our institutional Vascular Quality Initiative registry database. The composite outcome of discharge to a nonhome location or 30-day mortality was evaluated using bivariate and multivariate regression models.

RESULTS

A total of 134 independent patients were assessed using the CFS before they underwent elective open abdominal aortic aneurysm repair (8%), endovascular aneurysm repair (26%), thoracic endovascular aortic repair (6%), suprainguinal bypass (6%), infrainguinal bypass (16%), carotid endarterectomy (19%), or peripheral vascular intervention (20%). Among 39 (29%) individuals categorized as being frail using the CFS, there was no significant difference in age or American Society of Anesthesiologists physical status compared with nonfrail patients. However, frail patients were significantly more likely to need mobility assistance after surgery (62% frail vs 22% nonfrail; P < .01) and to be discharged to a nonhome location (22% frail vs 6% nonfrail; P = .01) or to die within 30 days after surgery (8% frail vs 0% nonfrail; P < .01). Preoperative frailty was associated with a >12-fold higher risk (odds ratio, 12.1; 95% confidence interval, 2.17-66.96; P < .01) of 30-day mortality or loss of independence, independent of the vascular procedure undertaken.

CONCLUSIONS

The CFS is a practical tool for assessing preoperative frailty among patients undergoing elective major vascular surgery and can be used to predict likelihood of requiring discharge to a nursing facility or death after surgery. The identification of frail patients before major surgery can help manage postoperative expectations and optimize transitions of care.

Authors+Show Affiliations

Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah.Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah.Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah.Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah.Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah.Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah.Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah.Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah.Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah. Electronic address: benjamin.brooke@hsc.utah.edu.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29773431

Citation

Donald, Graham W., et al. "Preoperative Frailty Assessment Predicts Loss of Independence After Vascular Surgery." Journal of Vascular Surgery, vol. 68, no. 5, 2018, pp. 1382-1389.
Donald GW, Ghaffarian AA, Isaac F, et al. Preoperative frailty assessment predicts loss of independence after vascular surgery. J Vasc Surg. 2018;68(5):1382-1389.
Donald, G. W., Ghaffarian, A. A., Isaac, F., Kraiss, L. W., Griffin, C. L., Smith, B. K., Sarfati, M. R., Beckstrom, J. L., & Brooke, B. S. (2018). Preoperative frailty assessment predicts loss of independence after vascular surgery. Journal of Vascular Surgery, 68(5), 1382-1389. https://doi.org/10.1016/j.jvs.2018.02.044
Donald GW, et al. Preoperative Frailty Assessment Predicts Loss of Independence After Vascular Surgery. J Vasc Surg. 2018;68(5):1382-1389. PubMed PMID: 29773431.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preoperative frailty assessment predicts loss of independence after vascular surgery. AU - Donald,Graham W, AU - Ghaffarian,Amir A, AU - Isaac,Farid, AU - Kraiss,Larry W, AU - Griffin,Claire L, AU - Smith,Brigitte K, AU - Sarfati,Mark R, AU - Beckstrom,Julie L, AU - Brooke,Benjamin S, PY - 2017/10/25/received PY - 2018/02/24/accepted PY - 2018/5/19/pubmed PY - 2019/3/15/medline PY - 2018/5/19/entrez KW - Frailty KW - Loss of independence KW - Risk assessment KW - Vascular surgery SP - 1382 EP - 1389 JF - Journal of vascular surgery JO - J Vasc Surg VL - 68 IS - 5 N2 - OBJECTIVE: Frailty, a clinical syndrome associated with loss of metabolic reserves, is prevalent among patients who present to vascular surgery clinics for evaluation. The Clinical Frailty Scale (CFS) is a rapid assessment method shown to be highly specific for identifying frail patients. In this study, we sought to evaluate whether the preoperative CFS score could be used to predict loss of independence after major vascular procedures. METHODS: We identified all patients living independently at home who were prospectively assessed using the CFS before undergoing an elective major vascular surgery procedure (admitted for >24 hours) at an academic medical center between December 2015 and December 2017. Patient- and procedure-level clinical data were obtained from our institutional Vascular Quality Initiative registry database. The composite outcome of discharge to a nonhome location or 30-day mortality was evaluated using bivariate and multivariate regression models. RESULTS: A total of 134 independent patients were assessed using the CFS before they underwent elective open abdominal aortic aneurysm repair (8%), endovascular aneurysm repair (26%), thoracic endovascular aortic repair (6%), suprainguinal bypass (6%), infrainguinal bypass (16%), carotid endarterectomy (19%), or peripheral vascular intervention (20%). Among 39 (29%) individuals categorized as being frail using the CFS, there was no significant difference in age or American Society of Anesthesiologists physical status compared with nonfrail patients. However, frail patients were significantly more likely to need mobility assistance after surgery (62% frail vs 22% nonfrail; P < .01) and to be discharged to a nonhome location (22% frail vs 6% nonfrail; P = .01) or to die within 30 days after surgery (8% frail vs 0% nonfrail; P < .01). Preoperative frailty was associated with a >12-fold higher risk (odds ratio, 12.1; 95% confidence interval, 2.17-66.96; P < .01) of 30-day mortality or loss of independence, independent of the vascular procedure undertaken. CONCLUSIONS: The CFS is a practical tool for assessing preoperative frailty among patients undergoing elective major vascular surgery and can be used to predict likelihood of requiring discharge to a nursing facility or death after surgery. The identification of frail patients before major surgery can help manage postoperative expectations and optimize transitions of care. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/29773431/Preoperative_frailty_assessment_predicts_loss_of_independence_after_vascular_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(18)30822-X DB - PRIME DP - Unbound Medicine ER -