Utility of Preoperative Frailty Indices for Predicting Ambulatory Vascular Surgery Clinical Outcomes: A Single Center Study
JungEun Ahn1, Deanna McIntire2, M. Libby Weaver3, Margaret C Tracci3, W. Darrin Clouse3, Behzad Farivar3
1University of Virginia School of Medicine, Charlottesville, VA;2University of Virginia Health System, Charlottesville, VA;3Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
INTRODUCTION: Frailty has been a subject of recent interest as a potential predictor of clinical outcomes of vascular disease and surgery, particularly mortality. However, there has been large heterogeneity in the frailty indices selected for analysis. The aim of the present study was to assess whether pre-operative frailty assessment performed at a single institution could be used to predict clinical outcomes of vascular surgery.
METHODS: This was a retrospective cohort of patients who underwent a battery of pre-operative frailty assessments at a single institution vascular surgery clinic from February 2021 to January 2022. Patients were categorized as frail based on three frailty indices: the Fried Frailty Index (FFI), the Short Physical Performance Battery (SPPB), and the Essential Frailty Toolset (EFT). Univariate and multivariate analysis was utilized to assess the relationship between frailty and peri-operative outcomes.
RESULTS: A total of 139 patients that underwent 146 procedures underwent comprehensive, pre-operative frailty evaluation. The mean patient age was 70.3 ± 10.3 years, and 36% were women. A total of 81 open or hybrid procedures and 65 endovascular procedures were performed. On univariate analysis, frailty based on FFI, SPPB, and EFT were not significantly associated with the incidence of non-home discharge, hospital length of stay greater than seven days, thirty-day hospital readmission, unplanned re-operation within 30 days, or peri-operative complications. Age over 74 was associated with non-home discharge and open surgery was associated with an extended hospital stay. FFI, SPPB, and EFT were not independent predictors of non-home discharge or extended hospital stay after multivariate analysis accounting for patient age, gender, and type of procedure (open vs endovascular).
CONCLUSIONS: In this single-center retrospective study, three separate frailty indices (FFI, SPPB, EFT) did not predict short-term clinical outcomes of elective/ambulatory vascular surgery procedures. Additional investigation is needed to determine if frailty indices can be used to predict short-term clinical outcomes of vascular surgery procedures.
| Variable | Non-Home Discharge (95% CI) | LOS Greater than 7 Days (95% CI) | Re-admission in 30 Days (95% CI) | Re-operate in 30 Days (95% CI) | Peri-operative Complications (95% CI) |
| Age over 74 | 4.34 (1.64 - 11.47) | 1.59 (0.65 - 3.90) | 2.43 (0.73 - 8.07) | 4.40 (0.82 - 23.52) | 1.27 (0.65 - 2.49) |
| Open or Hybrid Procedure | 1.88 (0.72 - 4.94) | 3.43 (1.20 - 9.82) | 1.83 (0.55 - 6.08) | 3.35 (0.63 - 17.86) | 1.73 (0.88 - 3.39) |
| Frailty based on SPPB | 1.24 (0.45 - 3.37) | 0.71 (0.27 - 1.90) | 0.54 (0.14 - 2.12) | 1.51 (0.29 - 7.79) | 1.05 (0.52 - 2.15) |
| Frailty based on FFI | 1.96 (0.75 - 5.14) | 1.09 (0.40 - 3.03) | 1.59 (0.45 - 5.64) | 1.224 (0.23 - 6.60) | 0.89 (0.41 - 1.91) |
| Frailty based on EFT | 1.71 (0.50 - 5.92) | 1.59 (0.46 - 5.48) | 3.00 (0.69 - 12.97) | 4.49 (0.69 - 29.11) | 1.33 (0.48 - 3.73) |
| Variables | Non-Home Discharge (95% CI) | LOS Greater than 7 Days (95% CI) |
| Frailty based on SPPB | 1.18 (0.34 - 4.09) | 1.492 (0.51 - 4.35) |
| Frailty based on FFI | 0.524 (0.18 - 1.55) | 0.797 (0.27 - 2.34) |
| Frailty based on EFT | 0.763 (0.18 - 3.19) | 0.462 (0.11 - 1.89) |
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