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

Abstract

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.

Prevalence and adverse outcomes of pre-operative frailty in patients undergoing carotid artery revascularization: a meta-analysis

“…Recent researches showed that due to aging of body function, atherosclerosis, and other factors, patients undergoing carotid artery revascularization have a high degree of pre-operative frailty ( 38 , 39 ). Banning ( 40 ) found that the prevalence of pre-operative frailty of CEA is 23.9%, lower than the results of this study, which may be related to the inclusion of CAS patients and expanded sample size in this study.…”

Prognostic significance of gamma‐glutamyl transpeptidase to albumin ratio in patients with intrahepatic cholangiocarcinoma after hepatectomy

“… 25 , 26 Studies demonstrated that high GGT level was associated with the poor prognosis of patients with various tumours, including CCA. 27 , 28 Albumin is an important component in human plasma and a good indicator of liver dysfunction and malnutrition. The albumin level in the body obviously affected the survival time of cancer patient.…”

“…GGT as a ubiquitous epithelial enzyme was believed to be related to cardiovascular disease and chronic kidney disease 25,26 . Studies demonstrated that high GGT level was associated with the poor prognosis of patients with various tumours, including CCA 27,28 . Albumin is an important component in human plasma and a good indicator of liver dysfunction and malnutrition.…”

Does Preoperative Cognitive Optimization Improve Postoperative Outcomes in the Elderly?

“…Frailty syndrome is measured as the sum of various indicators, including unintentional weight loss, fatigue, muscle weakness, low physical activity, low gait speed, poor balance, visual impairment, and cognitive impairment [41,42]. The prevalence of preoperative frailty varies significantly (up to 50-60%) depending on age and the type of surgery, with a steep increase observed in older patients [43][44][45][46]. Preoperative frailty is known to be associated with poor postoperative morbidity and mortality [47].…”