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Prognostic implications of diagnosing frailty and sarcopenia in vascular surgery practice.
J Vasc Surg. 2019 Sep; 70(3):892-900.JV

Abstract

OBJECTIVE

Frailty and sarcopenia are related but independent conditions commonly diagnosed in older patients that can be used to assess their ability to tolerate the stress of major vascular surgery. For surgical decision-making, however, it is important to know the prognostic implications associated with each of these conditions. The study was designed to assess the association of frailty and sarcopenia phenotypes with long-term survival of patients undergoing surgical and nonsurgical management of vascular disease.

METHODS

We retrospectively reviewed all patients presenting to the vascular surgery clinic at an academic hospital between December 2015 and August 2017 who underwent prospective frailty assessment with the Clinical Frailty Scale and who had abdominal computed tomography (CT) scans performed within the preceding 12 months. A single axial CT image at the caudal end of the third lumbar vertebra was assessed to measure cross-sectional areas of skeletal muscle. Sarcopenia was defined by established criteria specific for male and female patients. After patients were stratified by frailty and sarcopenia diagnoses along with comorbidities, the association with all-cause mortality was analyzed by Kaplan-Meier curves and Cox regression models.

RESULTS

A total of 415 patients underwent both frailty and sarcopenia assessment, of whom 112 (27%) met sarcopenia criteria alone, 48 (12%) met only frailty criteria, and 56 (13%) met criteria for both phenotypes. There were 199 (48%) controls who met neither criterion. Vascular operations were performed in 167 (40%) patients after frailty and sarcopenia assessment, whereas 248 (60%) patients were managed nonoperatively with median (interquartile range) follow-up after CT imaging of 1.5 (1.1-2.2) years. Patients diagnosed with either phenotype were older (mean, 65 years vs 59 years; P < .001) and more likely to be male (69% vs 54%; P < .001) compared with patients without sarcopenia or frailty. Long-term survival was significantly decreased for patients diagnosed with either frailty alone or frailty and sarcopenia who underwent surgical or nonsurgical management (log-rank, P < .001 for both comparisons). In multivariate regression models, however, frailty was the only independent variable (hazard ratio, 7.7; 95% confidence interval, 3.2-18.7; P < .001) that predicted mortality.

CONCLUSIONS

Frailty and sarcopenia overlap to varying degrees in patients presenting to vascular surgery clinics and can be used alone or in combination to predict long-term survival of older patients. However, our data indicate that it was only the diagnosis of frailty that was an independent predictor of mortality and had the strongest prognostic significance in patients undergoing both surgical and nonoperative management.

Authors+Show Affiliations

Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash.Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah. Electronic address: benjamin.brooke@hsc.utah.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30850295

Citation

Ghaffarian, Amir A., et al. "Prognostic Implications of Diagnosing Frailty and Sarcopenia in Vascular Surgery Practice." Journal of Vascular Surgery, vol. 70, no. 3, 2019, pp. 892-900.
Ghaffarian AA, Foss WT, Donald G, et al. Prognostic implications of diagnosing frailty and sarcopenia in vascular surgery practice. J Vasc Surg. 2019;70(3):892-900.
Ghaffarian, A. A., Foss, W. T., Donald, G., Kraiss, L. W., Sarfati, M., Griffin, C. L., Smith, B. K., & Brooke, B. S. (2019). Prognostic implications of diagnosing frailty and sarcopenia in vascular surgery practice. Journal of Vascular Surgery, 70(3), 892-900. https://doi.org/10.1016/j.jvs.2018.11.025
Ghaffarian AA, et al. Prognostic Implications of Diagnosing Frailty and Sarcopenia in Vascular Surgery Practice. J Vasc Surg. 2019;70(3):892-900. PubMed PMID: 30850295.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic implications of diagnosing frailty and sarcopenia in vascular surgery practice. AU - Ghaffarian,Amir A, AU - Foss,Wylie T, AU - Donald,Graham, AU - Kraiss,Larry W, AU - Sarfati,Mark, AU - Griffin,Claire L, AU - Smith,Brigitte K, AU - Brooke,Benjamin S, Y1 - 2019/03/06/ PY - 2018/07/21/received PY - 2018/11/05/accepted PY - 2019/3/10/pubmed PY - 2020/1/30/medline PY - 2019/3/10/entrez KW - Frailty KW - Risk assessment KW - Sarcopenia KW - Vascular surgery procedures SP - 892 EP - 900 JF - Journal of vascular surgery JO - J Vasc Surg VL - 70 IS - 3 N2 - OBJECTIVE: Frailty and sarcopenia are related but independent conditions commonly diagnosed in older patients that can be used to assess their ability to tolerate the stress of major vascular surgery. For surgical decision-making, however, it is important to know the prognostic implications associated with each of these conditions. The study was designed to assess the association of frailty and sarcopenia phenotypes with long-term survival of patients undergoing surgical and nonsurgical management of vascular disease. METHODS: We retrospectively reviewed all patients presenting to the vascular surgery clinic at an academic hospital between December 2015 and August 2017 who underwent prospective frailty assessment with the Clinical Frailty Scale and who had abdominal computed tomography (CT) scans performed within the preceding 12 months. A single axial CT image at the caudal end of the third lumbar vertebra was assessed to measure cross-sectional areas of skeletal muscle. Sarcopenia was defined by established criteria specific for male and female patients. After patients were stratified by frailty and sarcopenia diagnoses along with comorbidities, the association with all-cause mortality was analyzed by Kaplan-Meier curves and Cox regression models. RESULTS: A total of 415 patients underwent both frailty and sarcopenia assessment, of whom 112 (27%) met sarcopenia criteria alone, 48 (12%) met only frailty criteria, and 56 (13%) met criteria for both phenotypes. There were 199 (48%) controls who met neither criterion. Vascular operations were performed in 167 (40%) patients after frailty and sarcopenia assessment, whereas 248 (60%) patients were managed nonoperatively with median (interquartile range) follow-up after CT imaging of 1.5 (1.1-2.2) years. Patients diagnosed with either phenotype were older (mean, 65 years vs 59 years; P < .001) and more likely to be male (69% vs 54%; P < .001) compared with patients without sarcopenia or frailty. Long-term survival was significantly decreased for patients diagnosed with either frailty alone or frailty and sarcopenia who underwent surgical or nonsurgical management (log-rank, P < .001 for both comparisons). In multivariate regression models, however, frailty was the only independent variable (hazard ratio, 7.7; 95% confidence interval, 3.2-18.7; P < .001) that predicted mortality. CONCLUSIONS: Frailty and sarcopenia overlap to varying degrees in patients presenting to vascular surgery clinics and can be used alone or in combination to predict long-term survival of older patients. However, our data indicate that it was only the diagnosis of frailty that was an independent predictor of mortality and had the strongest prognostic significance in patients undergoing both surgical and nonoperative management. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/30850295/Prognostic_implications_of_diagnosing_frailty_and_sarcopenia_in_vascular_surgery_practice_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(19)30054-0 DB - PRIME DP - Unbound Medicine ER -