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Pre-Frailty Impacts Outcomes Of Interventions For Chronic Limb-Threatening Ischemia
Mark G Davies
1, Joseph P Hart
2 1Ascension Health, Waco, TX;
2MCW, Milwaukee, WI
Background: Frailty is increasingly common among surgical patients and predicts poor surgical outcomes. This study aimed to analyze the impact of the pre frail state in patients undergoing lower extremity care for chronic limb-threatening ischemia (CLTI).
Methods: Between 2018 and 2024, all patients undergoing a primary intervention for CLTI (endovascular intervention-EV, bypass BYP, major amputation-AMP) or Wound Care (WOUND) were analyzed. The 11-point modified frailty index (mFI-11) was used to stratify patients based on frailty: mFI-11 = 0 was robust, mFI-11 = 1 was prefrail, mFI-11 = 2 was frail, and mFI-11 = 3 + was characterized as severely frail. 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: 2118 patients (56% male, age 65±11years, mean ± SD) underwent EV (52%), BYP (29%), AMP (13%), or WOUND (6%). While 58% were considered frail on initial evaluation, an additional 25% were considered pre-frail. The prefrail group performed worse than the Robust group in terms of both short-term and long-term outcomes (
Table 1). The prefrail group also demonstrated equivalent short-term and long-term outcomes to the frail patients (
Table 1). Age greater than 70 years, a high Charlson comorbidity index (>4), and a poor Prognostic Nutritional Index were associated with the prefrail state.
Conclusions: Up to a quarter of patients presenting with CLTI are considered pre-frail, and pre-frailty is associated with worse outcomes than robust patients but better outcomes than those of frail patients.
Identifying the prefrail patient may offer the opportunity for prehabilitation and post-rehabilitation to improve outcomes.
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