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Outpatient grip strength measurement predicts survival, perioperative adverse events, and nonhome discharge among patients with vascular disease.
J Vasc Surg. 2021 01; 73(1):250-257.JV

Abstract

OBJECTIVES

Frailty is associated with adverse outcomes among patients with vascular disease. Grip strength measurement is a comparatively simple, quick, and inexpensive screening test for weakness (a component of frailty) that is potentially applicable to clinical practice. We hypothesized that grip strength and categorical weakness are associated with clinical outcomes among patients with vascular disease. To test this hypothesis, we conducted a longitudinal cohort study evaluating associations between grip strength measured during outpatient clinic visits for vascular disease and clinical outcomes, including survival and perioperative outcomes.

METHODS

Adult patients recruited from outpatient vascular surgery and/or vascular medicine clinics underwent dominant hand grip strength measurement using a hand dynamometer. Participants were categorized as weak based on grip strength, sex, and body mass index. Multivariable logistic models were used to evaluate perioperative outcomes. Mortality was evaluated using Cox proportional hazards models adjusted for sex, age, and operative intervention during follow-up.

RESULTS

We enrolled 321 participants. The mean patients age was 69.0 ± 9.4 years, and 33% were women. Mean grip strength was 32.0 ± 12.1 kg, and 92 participants (29%) were categorized as weak. The median follow-up was 24.0 months. Adverse perioperative events occurred in 32 of 84 patients undergoing procedures. Grip strength was associated with decreased risk of perioperative adverse events (hazard ratio [HR], 0.41 per 12.7 kg increase; 95% confidence interval [CI], 0.20-0.85; P = .0171) in a model adjusted for open versus endovascular procedure (HR, 12.75 for open; 95% CI, 2.54-63.90; P = .0020) and sex (HR, 3.05 for male; 95% CI, 0.75-12.4; P = .120). Grip strength was also associated with a lower risk of nonhome discharge (HR, 0.34 per 12.7 kg increase; 95% CI, 0.14-0.82; P = .016) adjusted for sex (HR, 2.14 for male; 95% CI, 0.48-9.50; P = .31) and open versus endovascular procedure (HR, 10.36 for open; 95% CI, 1.20-89.47; P = .034). No associations between grip strength and length of stay were observed. Mortality occurred in 48 participants (14.9%) during follow-up. Grip strength was inversely associated with mortality (HR, 0.46 per 12.5 kg increase; 95% CI, 0.29-0.73; P = .0009) in a model adjusted for sex (HR, 5.08 for male; 95% CI, 2.1-12.3; P = .0003), age (HR, 1.04 per year; 95% CI, 1.01-1.08), and operative intervention during follow-up (HR, 1.23; 95% CI, 0.71-2.52). Categorical weakness was also associated with mortality (HR, 1.81 vs nonfrail; P = .048) in a model adjusted for age (HR, 1.06 per year; P = .002) and surgical intervention (HR, 1.36; 95% CI, 1.02-0.09; P = .331).

CONCLUSIONS

Grip strength is associated with all-cause mortality, perioperative adverse events, and nonhome discharge among patients with vascular disease. These observations support the usefulness of grip strength as a simple and inexpensive risk screening tool for patients with vascular disease.

Authors+Show Affiliations

Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC.Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.Section of Vascular Surgery, University of Michigan, Ann Arbor, Mich. Electronic address: mcorrier@med.umich.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32360376

Citation

Reeve, Thomas E., et al. "Outpatient Grip Strength Measurement Predicts Survival, Perioperative Adverse Events, and Nonhome Discharge Among Patients With Vascular Disease." Journal of Vascular Surgery, vol. 73, no. 1, 2021, pp. 250-257.
Reeve TE, Craven TE, Goldman MP, et al. Outpatient grip strength measurement predicts survival, perioperative adverse events, and nonhome discharge among patients with vascular disease. J Vasc Surg. 2021;73(1):250-257.
Reeve, T. E., Craven, T. E., Goldman, M. P., Hurie, J. B., Velazquez-Ramirez, G., Edwards, M. S., & Corriere, M. A. (2021). Outpatient grip strength measurement predicts survival, perioperative adverse events, and nonhome discharge among patients with vascular disease. Journal of Vascular Surgery, 73(1), 250-257. https://doi.org/10.1016/j.jvs.2020.03.060
Reeve TE, et al. Outpatient Grip Strength Measurement Predicts Survival, Perioperative Adverse Events, and Nonhome Discharge Among Patients With Vascular Disease. J Vasc Surg. 2021;73(1):250-257. PubMed PMID: 32360376.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outpatient grip strength measurement predicts survival, perioperative adverse events, and nonhome discharge among patients with vascular disease. AU - Reeve,Thomas E,4th AU - Craven,Timothy E, AU - Goldman,Matthew P, AU - Hurie,Justin B, AU - Velazquez-Ramirez,Gabriela, AU - Edwards,Matthew S, AU - Corriere,Matthew A, Y1 - 2020/05/01/ PY - 2019/09/12/received PY - 2020/03/20/accepted PY - 2020/5/4/pubmed PY - 2021/5/4/medline PY - 2020/5/4/entrez KW - Complications KW - Frailty KW - Grip strength KW - Perioperative evaluation KW - Risk screening KW - Risk stratification KW - Survival KW - Weakness SP - 250 EP - 257 JF - Journal of vascular surgery JO - J Vasc Surg VL - 73 IS - 1 N2 - OBJECTIVES: Frailty is associated with adverse outcomes among patients with vascular disease. Grip strength measurement is a comparatively simple, quick, and inexpensive screening test for weakness (a component of frailty) that is potentially applicable to clinical practice. We hypothesized that grip strength and categorical weakness are associated with clinical outcomes among patients with vascular disease. To test this hypothesis, we conducted a longitudinal cohort study evaluating associations between grip strength measured during outpatient clinic visits for vascular disease and clinical outcomes, including survival and perioperative outcomes. METHODS: Adult patients recruited from outpatient vascular surgery and/or vascular medicine clinics underwent dominant hand grip strength measurement using a hand dynamometer. Participants were categorized as weak based on grip strength, sex, and body mass index. Multivariable logistic models were used to evaluate perioperative outcomes. Mortality was evaluated using Cox proportional hazards models adjusted for sex, age, and operative intervention during follow-up. RESULTS: We enrolled 321 participants. The mean patients age was 69.0 ± 9.4 years, and 33% were women. Mean grip strength was 32.0 ± 12.1 kg, and 92 participants (29%) were categorized as weak. The median follow-up was 24.0 months. Adverse perioperative events occurred in 32 of 84 patients undergoing procedures. Grip strength was associated with decreased risk of perioperative adverse events (hazard ratio [HR], 0.41 per 12.7 kg increase; 95% confidence interval [CI], 0.20-0.85; P = .0171) in a model adjusted for open versus endovascular procedure (HR, 12.75 for open; 95% CI, 2.54-63.90; P = .0020) and sex (HR, 3.05 for male; 95% CI, 0.75-12.4; P = .120). Grip strength was also associated with a lower risk of nonhome discharge (HR, 0.34 per 12.7 kg increase; 95% CI, 0.14-0.82; P = .016) adjusted for sex (HR, 2.14 for male; 95% CI, 0.48-9.50; P = .31) and open versus endovascular procedure (HR, 10.36 for open; 95% CI, 1.20-89.47; P = .034). No associations between grip strength and length of stay were observed. Mortality occurred in 48 participants (14.9%) during follow-up. Grip strength was inversely associated with mortality (HR, 0.46 per 12.5 kg increase; 95% CI, 0.29-0.73; P = .0009) in a model adjusted for sex (HR, 5.08 for male; 95% CI, 2.1-12.3; P = .0003), age (HR, 1.04 per year; 95% CI, 1.01-1.08), and operative intervention during follow-up (HR, 1.23; 95% CI, 0.71-2.52). Categorical weakness was also associated with mortality (HR, 1.81 vs nonfrail; P = .048) in a model adjusted for age (HR, 1.06 per year; P = .002) and surgical intervention (HR, 1.36; 95% CI, 1.02-0.09; P = .331). CONCLUSIONS: Grip strength is associated with all-cause mortality, perioperative adverse events, and nonhome discharge among patients with vascular disease. These observations support the usefulness of grip strength as a simple and inexpensive risk screening tool for patients with vascular disease. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/32360376/Outpatient_grip_strength_measurement_predicts_survival_perioperative_adverse_events_and_nonhome_discharge_among_patients_with_vascular_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(20)31090-9 DB - PRIME DP - Unbound Medicine ER -