Influence of frailty on treatment outcomes after revascularization in patients with critical limb ischemia

Morisaki, Koichi; Yamaoka, Terutoshi; Iwasa, Kazuomi; Ohmine, Takahiro

doi:10.1016/j.jvs.2017.04.048

Cited by 60 publications

(48 citation statements)

References 13 publications

(17 reference statements)

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“…Limb Ischaemia Frailty Index. 25 Six single domain tools were used in 11 studies examining four areas: cognition, 7 function dependency, 32,33,38 central muscle mass, 10,11,36,37,39,40 and nutrition. 35 Six studies were conducted in patients who underwent major vascular surgery, 7,8,28,30,31,34 nine studies in patients with AAA, 11,12,14,27,33,36e39 and 10 studies in patients with LEAD.…”

Section: And Criticalmentioning

confidence: 99%

See 1 more Smart Citation

The Impact of Frailty on Outcomes of Elderly Patients After Major Vascular Surgery: A Systematic Review and Meta-analysis

Wang

Zou

Zhao

et al. 2018

European Journal of Vascular and Endovascular Surgery

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Section: And Criticalmentioning

confidence: 99%

“…35 Six studies were conducted in patients who underwent major vascular surgery, 7,8,28,30,31,34 nine studies in patients with AAA, 11,12,14,27,33,36e39 and 10 studies in patients with LEAD. 10,13,15,25,26,29,32,33,35,40 The basic characteristics of the included studies are given in Table 1.…”

Section: And Criticalmentioning

confidence: 99%

The Impact of Frailty on Outcomes of Elderly Patients After Major Vascular Surgery: A Systematic Review and Meta-analysis

Wang

Zou

Zhao

et al. 2018

European Journal of Vascular and Endovascular Surgery

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“…Regardless of the measure, frailty has been shown to be an independent risk factor for poor outcomes across surgical specialties, including vascular surgery. [2][3][4][5][6][7][8][9][10][11][12][13] In 2014 in the United States alone, abdominal aortic aneurysms (AAA) were directly responsible for w9,900 deaths, and w120,000 AAA repairs were performed to prevent subsequent rupture. 14 Independent of other comorbidities, increased frailty has been found to predict higher 30-day mortality, morbidity, and failure to rescue after both open AAA repair (OAR) and endovascular AAA repair (EVAR); however, the impact of frailty on long-term survival after elective AAA repair has not been examined.…”

mentioning

confidence: 99%

Variation in center-level frailty burden and the impact of frailty on long-term survival in patients undergoing elective repair for abdominal aortic aneurysms

George

Chen

Trickey

et al. 2020

Journal of Vascular Surgery

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Objective: Frailty is increasingly recognized as a key determinant in predicting postoperative outcomes. Centers that see more frail patients may not be captured in risk adjustment, potentially accounting for poorer outcomes in hospital comparisons. We aimed to (1) determine the effect of frailty on long-term mortality in patients undergoing elective abdominal aortic aneurysm (AAA) repair and (2) evaluate the variability in frailty burden among centers in the Vascular Quality Initiative (VQI) database. Methods:Patients undergoing elective open and endovascular AAA repair (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017) were identified, and those with complete data on component variables of the VQI-derived Risk Analysis Index (VQI-RAI) and centers with $10 AAA repairs were included. VQI-RAI characteristics are sex, age, body mass index, renal failure, congestive heart failure, dyspnea, preoperative ambulation, and functional status. Frailty was defined as VQI-RAI $35 based on prior work in surgical patients using other quality improvement databases. This corresponds to the top 12% of patients at risk in the VQI. Center-level VQI-RAI differences were assessed by analysis of variance test. Relationships between frailty and survival were compared by Kaplan-Meier analysis and the log-rank test for open and endovascular procedures. Multivariable hierarchical Cox proportional hazards regression models were calculated with random intercepts for center, controlling for frailty, race, insurance, AAA diameter, procedure type, AAA case mix, and year.Results: A total of 15,803 patients from 185 centers were included. Mean VQI-RAI scores were 27.6 (standard deviation, 5.9; range, 4-56) and varied significantly across centers (F ¼ 2.41, P < .001). The percentage of frail patients per center ranged from 0% to 40.0%. In multivariable analysis, frailty was independently associated with long-term mortality (hazard ratio, 2.88; 95% confidence interval, 2.6-3.2) after accounting for covariates and center-level variance. Open AAA repair was not associated with long-term mortality after adjusting for frailty (hazard ratio, 0.98; 95% confidence interval, 0.86-1.13). There was a statistically significant difference in the percentage of frail patients compared with nonfrail patients who were discharged to a rehabilitation facility or nursing home after both open (40.5% vs 17.8%; P < .0001) and endovascular repair (17.7% vs 4.6%; P < .0001). Conclusions:There is considerable variability of preoperative frailty among VQI centers performing elective AAA repair. Adjusting for center-level variation, frailty but not procedure type had a significant association with long-term mortality; however, frailty and procedure type were both associated with nonhome discharge. Routine measurement of frailty preoperatively by centers to identify high-risk patients may help mitigate procedural and long-term outcomes and improve shared decision-making regarding AAA repair. (J Vasc Surg 2020;71:46-55.)

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“…Moreover, the CLI Frailty Index was significantly influencing the mortality rate 2 years after amputation-free survival (AFS). This finding can improve the prognostic prediction of outcome and could help clinicians in the selection of firstly applying treatment strategy 40. Examining gender differences in a propensity score-matched analysis after lower limb endovascular interventions and a 1-year follow-up period, the following results were reported: women were at lower risk of mortality than men, despite that they underwent significantly more repeated revascularization procedures 41.…”

Section: Resultsmentioning

confidence: 97%

<p>Frailty In Patients Undergoing Vascular Surgery: A Narrative Review Of Current Evidence</p>

Czobor¹,

Lehot²,

Holndonner–Kirst³

et al. 2019

TCRM

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Frailty is presumably associated with an elevated risk of postoperative mortality and adverse outcome in vascular surgery patients. The aim of our review was to identify possible methods for risk assessment and prehabilitation in order to improve recovery and postoperative outcome. The literature search was performed via PubMed, Embase, OvidSP, and the Cochrane Library. We collected papers published in peer-reviewed journals between 2001 and 2018. The selection criterion was the relationship between vascular surgery, frailty and postoperative outcome or mortality. A total number of 52 publications were included. Frailty increases the risk of non-home discharge independently of presence or absence of postoperative complications and it is related to a higher 30-day mortality and major morbidity. The modified Frailty Index showed significant association with elevated risk for post-interventional stroke, myocardial infarction, prolonged in-hospital stays and higher readmission rates. When adjusted for comorbidity and surgery type, frailty seems to impact medium-term survival (within 2 years). Preoperative physical exercising, avoidance of hypalbuminemia, psychological and cognitive training, maintenance of muscle strength, adequate perioperative nutrition, and management of smoking behaviours are leading to a reduced length of stay and a decreased incidence of readmission rate, thus improving the effectiveness of early rehabilitation. Pre-frailty is a dynamically changing state of the patient, capable of deteriorating or improving over time. With goal-directed preoperative interventions, the decline can be prevented.

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Influence of frailty on treatment outcomes after revascularization in patients with critical limb ischemia

Abstract: The CLI Frailty Index is a risk factor for 2-year AFS in CLI patients after revascularization. This result could prove useful for prognostic prediction and decision-making in selection of bypass surgery or endovascular therapy as a first treatment strategy.

Cited by 60 publications

References 13 publications

The Impact of Frailty on Outcomes of Elderly Patients After Major Vascular Surgery: A Systematic Review and Meta-analysis

The Impact of Frailty on Outcomes of Elderly Patients After Major Vascular Surgery: A Systematic Review and Meta-analysis

Variation in center-level frailty burden and the impact of frailty on long-term survival in patients undergoing elective repair for abdominal aortic aneurysms

<p>Frailty In Patients Undergoing Vascular Surgery: A Narrative Review Of Current Evidence</p>

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