Transitions Of Frailty After Lower Extremity Interventions For Chronic Limb-Threatening Ischemia
Mark G Davies1, Joseph P Hart2
1Ascension Health, Waco, TX;2Medical College of Wisconsin, Milwaukee, WI
Background: Frailty is a common finding among surgical patients and predicts poor surgical outcomes. The aim of this study was to analyze transitions in frailty state among patients undergoing a lower extremity intervention for chronic limb-threatening ischemia (CLTI).
Methods: Between 2018 and 2022, all patients undergoing a primary intervention for CLTI (endovascular intervention-EV, bypass BYP, or major amputation-AMP) were analyzed. Frailty was assessed by VQI-derived Risk Analysis Index (VQI-RAI). Frailty was defined as a VQI-RAI score > 35 Transition in frailty state between preoperative and follow-up measurement at 1 month, 6 months, and 1 year were analyzed. Patient characteristics leading to a transition in frailty state were analyzed using multivariable Cox regression analysis. Amputation-free survival (AFS; survival without major amputation) and freedom from major adverse limb events (MALE; Above ankle amputation of the index limb or major re-intervention (new bypass graft, jump/interposition graft revision) were evaluated.
Results 1404 patients ( 61% male, age 64ą12years, meanąSD) underwent either EV (55%), a BYP (31%), or AMP (14%). 24% were considered frail on initial evaluation (28%, 16%, and 32% EV, BYP, and Amp, respectively). At 30 days, overall frailty increased to 34%: 10% of patients moved from Non-Frail to Frail, and 1% of patients moved from Frail to Non-Frail. At 1 year, overall frailty increased to 40%: 9% of patients shifted from Non-Frail to Frail, and 2% of patients shifted from Frail to Non-Frail (Table 1). At one year, frailty increased by 28% in EV, 16% for BYP, and 32% in AMP. There is an ongoing transition to a frail state in EV driven by a higher MALE rate. There is an initial transition to a frail state in BPY at 30 days, driven by the events of surgery. There is an ongoing transition to a frail state in AMP driven by a lack of prosthetic-assisted ambulation. Frailty at baseline, 30 days, and 1-year was associated with a high Charlson Comorbidity Index. Shifting to a frail state postoperatively was associated with decreased survival and a lower amputation-free survival at 1yr.
Conclusions: Following major interventions for CLTI at one year, 19% of patients shift from a Non-Frail to a Frail state, and 3% of patients shift from a Frail to a Non-Frail state with differences across modality. Shifting to a frail state is associated with poor outcomes and should be considered when evaluating and intervention in a patient with CLTI.
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