Preoperative frailty Risk Analysis Index to stratify patients undergoing carotid endarterectomy

Abstract

Frailty is a predictor of increased stroke, mortality, MI, and length of stay after CEA. An easily implemented RAI holds the potential to identify a limited subset of patients who are at higher risk for postoperative complications and may not benefit from CEA.

An Accumulated Deficits Model Predicts Perioperative and Long-Term Adverse Events After Carotid Endarterectomy

“…They suggested that the RAI or a similar screening tool of AD has the potential to help identify patients that may not benefit from CEA. 17 While our results have reinforced the results of some these initial publications, one of the major limitations of the data gleaned from large national databases is their lack of long-term follow-up. The advantage of our carotid database is the long clinical follow-up period: a mean of more than 4 years.…”

“…Elements from the 70-item FI developed from the Canadian Study of Health and Aging and from which the mFI was created and the RAI were mapped to items recorded in the database. 17,21 Seven items from the FI and RAI were recorded in our database including a history of hypertension, diabetes mellitus, chronic renal insufficiency, coronary artery disease, peripheral vascular disease, pulmonary disease, and congestive heart failure. These 7 comorbidities were tabulated to create an AD score for each patient (Table I).…”

“…10,11,[14][15][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 The major limitation of the existing analyses using the mFI and RAI is the use of national data sets which specifically lack long-term follow-up data. For CEA patients, especially asymptomatic patients in whom the objective is long-term stroke risk reduction, information about life expectancy and long-term outcomes beyond 30 days is critically important in decision-making.…”

Impact of frailty on surgical outcomes: The right patient for the right procedure

“…18 Similar findings have been reported in other ACS-NSQIP-based studies for emergent general operation, vascular, and orthopedic procedures. 1,[19][20][21] In a prospective cohort of 325 patients >65 years of age undergoing emergent general surgical procedures, Hewitt et al 10 noted an increased mortality in frail patients. However, the sample size in smaller institutional studies was inadequate to determine the association between frailty and mortality.…”

Frailty and Cardiovascular Disease

“…Furthermore, a study performed on patients undergoing carotid endarterectomy (CEA) using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2011 showed that frailty is a predictor of increased stroke, mortality, myocardial infarction, and length of stay after CEA, further supporting the idea that CVD and frailty are strongly interlinked with frail patients sufering poorer outcomes postintervention [65].…”