Premorbid function, comorbidity, and frailty predict outcomes after ruptured abdominal aortic aneurysm repair

Srinivasan, AV; Ambler, Graeme K.; Hayes, Paul D.; Chowdhury, Mohammed M.; Ashcroft, S. C.; Boyle, Jonathan R.; Coughlin, Patrick A.

doi:10.1016/j.jvs.2015.09.002

Cited by 30 publications

(25 citation statements)

References 34 publications

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“…Frailty itself has been shown to be a risk factor for death after surgery, even independent of age. 23,24 Although the VQI data set does not have a measure of frailty directly, octogenarian patients were significantly more dependent in their ambulatory status and living situation than the younger population.…”

Section: Discussionmentioning

confidence: 99%

Abdominal aortic aneurysm repair in octogenarians is associated with higher mortality compared with nonoctogenarians

Hicks

Obeid

Arhuidese

et al. 2016

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Abdominal aortic aneurysm repair in octogenarians is associated with higher mortality compared with nonoctogenarians

Hicks

Obeid

Arhuidese

et al. 2016

Journal of Vascular Surgery

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“…A large proportion of inpatients cared for by vascular surgery services care are aged 65 years and older, and many of these have multi‐morbidity and are frail. These patients are at risk of more complications, longer hospitalisations, higher mortality and greater dependence following surgery compared to younger and less frail patients . Delirium and functional decline are common complications in older vascular surgical patients .…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary quality improvement programme for older patients admitted to a vascular surgery ward^*

Mudge

McRae

Donovan

et al. 2020

Internal Medicine Journal

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Background Older vascular surgical patients are at high risk of hospital‐associated complications and prolonged stays. Aims To implement a multidisciplinary co‐management model for older vascular patients and evaluate impact on length of stay (LOS), delirium incidence, functional decline, medical complications and discharge destination. Methods Prospective pre‐post evaluation of a quality improvement intervention, enrolling pre‐intervention (August 2012–January 2013) and post‐intervention cohort (September 2013–March 2014). Participants were consenting patients aged 65 years and over admitted to the vascular surgical ward of a metropolitan teaching hospital for at least 3 days. Intervention was physician‐led co‐management plus a multidisciplinary improvement programme targeting delirium and functional decline. Primary outcomes were LOS, delirium and functional decline. Secondary outcomes were medical complications and discharge destination. Process measures included documented consultation patterns. Administrative data were also compared for all patients aged 65 and older for 12 months pre‐ and post‐intervention. Results We enrolled 112 participants pre‐intervention and 123 participants post‐intervention. LOS was reduced post‐intervention (geometric mean 7.6 days vs 9.3 days; ratio of geometric means 0.82 (95% confidence interval CI0.68–1.00), P = 0.04). There was a trend to less delirium (18 (14.6%) vs 24 (21.4%), P = 0.17) and functional decline (18 (14.6%) vs 27 (24.3%), P = 0.06), with greatest reductions in the urgently admitted subgroup. Administrative data showed reduced median LOS (5.2 days vs 6 days, P = 0.03) and greater discharge home (72% vs 50%, P < 0.01). Conclusions Physician‐led co‐management plus a multidisciplinary improvement programme may reduce LOS and improve functional outcomes in older vascular surgical patients.

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“…13 These scores have consistently been confirmed as independent risk factors for predicting adverse outcomes for surgical patients across a range of specialties including vascular surgery. 10,11,14-16 Both the modified frailty index (mFI), an 11-point index developed in the American College of Surgeon National Surgical Quality Improvement Program (NSQIP) database, and the Risk Analysis Index (RAI), a simplified version of the Porock 6-month mortality index, have been validated in CEA patients in these national data sets demonstrating that an increasing number of AD is associated with increased 30-day adverse events after CEA including stroke, mortality, and length of stay. 11,17,18 …”

Section: Introductionmentioning

confidence: 99%

An Accumulated Deficits Model Predicts Perioperative and Long-term Adverse Events after Carotid Endarterectomy

Sridharan¹,

Chaer²,

Wu³

et al. 2018

Annals of Vascular Surgery

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Background There is increasing recognition that decreased reserve in multiple organ systems, known as accumulated deficits (AD), may better stratify perioperative risk than traditional risk indices. We hypothesized that an AD model would predict both perioperative adverse events and long-term survival after carotid endarterectomy (CEA), particularly important in asymptomatic patients. Methods Consecutive patients undergoing CEA between 1st January 2000 and 31st December 2010 were retrospectively identified. Seven of the deficit items from the Canadian Study of Health and Aging–frailty index (coronary disease, renal insufficiency, pulmonary disease, peripheral vascular disease, heart failure, hypertension, and diabetes) were tabulated for each patient. Predictors of perioperative and long-term outcomes were evaluated using regression analysis. Results About 1,782 CEAs in 1,496 patients (mean age: 71.3 ± 9.3 years, 56.3% male, 35.4% symptomatic) were included. The risk of major adverse events (stroke, death, or myocardial infarction) at 30 days for patients with ≤3 deficits was 2.53% vs. 8.81% for patients with ≥4 deficits (P < 0.001). For patients with ≥5 deficits, the risk was 15.18%. Each additional deficit increased the odds of a 30-day major adverse event and hospital stay >2 days by 1.64 (P < 0.001) and 1.15 (P < 0.001), respectively. In multivariate analysis, the presence of ≥4 deficits was more predictive of perioperative major adverse events (odds ratio [OR] = 3.62, P < 0.001) than symptomatology within 6 months (OR = 1.57, P = 0.08) or octogenarian status (OR = 2.00, P = 0.02). Kaplan-Meier analysis showed significantly decreased survival over time with accumulating deficits (P < 0.001). Patients with ≥4 deficits have a hazards ratio for death of 2.6 compared to patients with ≤3 deficits (P < 0.001). Overall survival is estimated at 79.5% (95% confidence interval [CI]: 0.77–0.82) at 5 years in patients with ≤3 deficits versus 52.4% (95% CI: 0.46–0.58) in patients with ≥4 deficits, respectively. In subgroup analysis of asymptomatic patients, 5-year survival for octogenarian male patients with ≥4 deficits was only 26.8%. For asymptomatic males aged 70–79 years with ≥4 deficits, 5-year survival was 59.9%. Conclusions An AD model is more predictive of perioperative adverse events after CEA than age or symptomatic status. This model remains predictive of long-term survival. In asymptomatic male octogenarians with 4 or more AD, 5-year survival is severely limited.

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Premorbid function, comorbidity, and frailty predict outcomes after ruptured abdominal aortic aneurysm repair

Cited by 30 publications

References 34 publications

Abdominal aortic aneurysm repair in octogenarians is associated with higher mortality compared with nonoctogenarians

Abdominal aortic aneurysm repair in octogenarians is associated with higher mortality compared with nonoctogenarians

Multidisciplinary quality improvement programme for older patients admitted to a vascular surgery ward^*

An Accumulated Deficits Model Predicts Perioperative and Long-term Adverse Events after Carotid Endarterectomy

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Premorbid function, comorbidity, and frailty predict outcomes after ruptured abdominal aortic aneurysm repair

Cited by 30 publications

References 34 publications

Abdominal aortic aneurysm repair in octogenarians is associated with higher mortality compared with nonoctogenarians

Abdominal aortic aneurysm repair in octogenarians is associated with higher mortality compared with nonoctogenarians

Multidisciplinary quality improvement programme for older patients admitted to a vascular surgery ward*

An Accumulated Deficits Model Predicts Perioperative and Long-term Adverse Events after Carotid Endarterectomy

Contact Info

Product

Resources

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Multidisciplinary quality improvement programme for older patients admitted to a vascular surgery ward^*