Frailty as measured by the Risk Analysis Index is associated with long-term death after carotid endarterectomy

Rothenberg, Kara A.; George, Elizabeth; Barreto, Nicolas B.; Chen, Rui; Samson, Kaeli; Johanning, Jason M.; Trickey, Amber W.; Arya, Shipra

doi:10.1016/j.jvs.2020.01.043

Cited by 19 publications

(20 citation statements)

References 32 publications

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“…After applying the in-and exclusion criteria, 2,686 articles were excluded. Out of the remaining 41 full-texts, 27 studies were excluded because of using a single-domain frailty tool, and six for miscellaneous reasons (i.e., full-text not accessible or no primary data presented), resulting in eight articles that were included in this systematic review (20)(21)(22)(23)(24)(25)(26)(27).…”

Section: Resultsmentioning

confidence: 99%

“…After quality assessment, six studies were identified as having low risk of bias (22)(23)(24)(25)(26)(27) and two studies as having moderate risk of bias (20,21) (Table 1). All studies focused on pre-operative frailty status (Table 2).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Seven were retrospective cohort studies (20,(22)(23)(24)(25)(26)(27) and one was a prospective cohort study (21). All studies were performed in the USA and six studies (20,(22)(23)(24)(25)27) used the same national database from the National Surgical Quality Improvement Project (NSQIP) to retrieve their data. The three different frailty tools used by the included studies are presented in Table 3 and consist of the Clinical Frailty Scale (CFS) to prospectively collect patient-reported data, and the Risk Analysis Index (RAI) and Modified Frailty Index (MFI) to retrospectively collect data, retrieved from medical records.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Seven out of eight studies (20,(22)(23)(24)(25)(26)(27) included the preoperative prevalence of frail and non-frail CEA patients and were therefore included in the pooled prevalence analysis (Figure 2). The pooled prevalence for pre-operative frailty was 22.07% (95% CI: 16.35-27.79), with a high level of heterogeneity (I 2 =100%, P<0.01).…”

Section: Prevalence Of Pre-operative Frailtymentioning

confidence: 99%

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Role of pre-operative frailty status in relation to outcome after carotid endarterectomy: a systematic review

Benjamens¹,

Bokkers²,

Zeebregts³

et al. 2021

Ann Transl Med

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Carotid endarterectomy (CEA) is a surgical treatment option to prevent ischemic cerebrovascular accidents. Patients that present with pre-operative frailty might have an elevated risk for unfavorable outcomes after the CEA. A systematic search, using Medline, Embase, Web of Science and Cochrane Database, was performed for relevant literature on frailty in patients undergoing CEA. The study protocol was registered with PROSPERO (CRD42020190345). Eight articles were included. The pooled prevalence for pre-operative frailty was 23.9% (95% CI: 12.98-34.82). A difference in the incidence of complications between frail and non-frail patients (6.4% vs. 5.2%, respectively) and a difference in hospital length of stay [2 (IQR: 2-3) days vs. 1 (IQR: 1-2) day, respectively] were described. The 30-day mortality after CEA was 0.6% for non-frail patients, 2.6% for frail patients, and 4.9% for very frail patients (P<0.001). For 3-year mortality, a >1.5-fold increased risk was found for frail patients (OR 1.7, 95% CI: 1.4-2.0) and a >2.5-fold increased risk for very frail patients (OR 2.6, 95% CI: 2.2-3.1). In conclusion, this review shows the impact of frailty on outcome after CEA. Pre-operative frailty assessment with a validated, multi-domain tool should be implemented in the clinical setting as it will provide information on post-operative surgical outcomes and mortality risk but also frailty trajectory and cognitive decline.

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Prevalence Of Pre-operative Frailtymentioning

confidence: 99%

See 2 more Smart Citations

Role of pre-operative frailty status in relation to outcome after carotid endarterectomy: a systematic review

Benjamens¹,

Bokkers²,

Zeebregts³

et al. 2021

Ann Transl Med

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“…In recent articles from the vascular surgery literature focusing on abdominal aortic aneurysm repair, carotid endarterectomy, and limb preservation procedures, outcomes are negatively affected regardless of the frailty measure utilized. [16][17][18] The ease of using a simplified frailty index is balanced by lacking more granular functional data such as walking abilities, ability to perform ADLs, or grip strength. Furthermore, the mFI-5 can be easily ascertained from the large available databases such as those maintained by Medicare, Veterans Affairs, or NSQIP.…”

Section: Discussionmentioning

confidence: 99%

5-Item Modified Frailty Index Predicts Outcomes After Below-Knee Amputation in the Vascular Quality Initiative Amputation Registry

Andersen

Gabel

Mannoia

et al. 2020

The American Surgeon

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Patient frailty indices are increasingly being utilized to anticipate post-operative complications. This study explores whether a 5-factor modified frailty index (mFI-5) is associated with outcomes following below-knee amputation (BKA). All BKAs in the vascular quality initiative (VQI) amputation registry from 2012-2017 were reviewed. Preoperative frailty status was determined with the mFI-5 which assigns one point each for history of diabetes, chronic obstructive pulmonary disease or active pneumonia, congestive heart failure, hypertension, and nonindependent functional status. Outcomes included 30-day mortality, unplanned return to odds ratio (OR), post-op myocardial infarction (MI), post-op SSI, all-cause complication, revision to higher level amputation, disposition status, and prosthetic use. 2040 BKAs were performed. Logistic regression showed an increasing mFI-5 score that was associated with higher risk of combined complications (OR 1.22, confidence interval [CI] 1.07-1.38, P < .05), 30-day mortality (OR 1.60, CI 1.19-2.16, P < .05), post-op MI (OR 1.79, CI 1.30-2.45, P < .05), and failure of long-term prosthetic use (OR 1.17, CI 1.03-1.32, P < .05). In the VQI, every one-point increase in mFI-5 is associated with an increased risk of 22% for combined complications, 60% for 30-day mortality, nearly 80% for post-op MI, and 17% for failure of prosthetic use in BKA patients. The mFI-5 frailty index should be incorporated into preoperative planning and risk stratification.

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Association of Smoking With Postprocedural Complications Following Open and Endovascular Interventions for Intermittent Claudication

Reitz

Althouse

Meyer³

et al. 2022

JAMA Cardiol

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IMPORTANCE Smoking is a key modifiable risk factor in the development and progression of peripheral artery disease, which often manifests as intermittent claudication (IC). Smoking cessation is a first-line therapy for IC, yet a minority of patients quit smoking prior to elective revascularization.OBJECTIVE To assess if preprocedural smoking is associated with an increased risk of early postprocedural complications following elective open and endovascular revascularization. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study used nearest-neighbor (1:1) propensity score matching of 2011 to 2019 data from the Veterans Affairs Surgical Quality Improvement Program, including all cases with a primary diagnosis of IC and excluding emergent cases, primary procedures that were not lower extremity revascularization, and patients with chronic limb-threatening ischemia within 30 days of the intervention. All data were abstracted

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Frailty as measured by the Risk Analysis Index is associated with long-term death after carotid endarterectomy

Cited by 19 publications

References 32 publications

Role of pre-operative frailty status in relation to outcome after carotid endarterectomy: a systematic review

Role of pre-operative frailty status in relation to outcome after carotid endarterectomy: a systematic review

5-Item Modified Frailty Index Predicts Outcomes After Below-Knee Amputation in the Vascular Quality Initiative Amputation Registry

Association of Smoking With Postprocedural Complications Following Open and Endovascular Interventions for Intermittent Claudication

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