Abstract
Physical frailty is a key risk factor associated with higher rates of major adverse events (MAEs) after surgery. Assessing physical frailty is often challenging among patients with chronic limb-threatening ischemia (CLTI) who are often unable to perform gait-based assessments because of the presence of plantar wounds. To test a frailty meter (FM) that does not rely on gait to determine the risk of occurrence of MAEs after revascularization for patients with CLTI. This cohort study included 184 consecutively recruited patients with CLTI at 2 tertiary care centers. After 32 individuals were excluded, 152 participants were included in the study. Data collection was conducted between May 2018 and June 2019. Physical frailty measurement within 1 week before limb revascularization and incidence of MAEs for as long as 1 month after surgery. The FM works by quantifying weakness, slowness, rigidity, and exhaustion during a 20-second repetitive elbow flexion-extension exercise using a wrist-worn sensor. The FM generates a frailty index (FI) ranging from 0 to 1; higher values indicate progressively greater severity of physical frailty. Of 152 eligible participants (mean [SD] age, 67.0 [11.8] years; 59 [38.8%] women), 119 (78.2%) were unable to perform the gait test, while all could perform the FM test. Overall, 53 (34.9%), 58 (38.1%), and 41 (27.0%) were classified as robust (FI <0.20), prefrail (FI ≥0.20 to <0.35), or frail (FI ≥0.35), respectively. Within 30 days after surgery, 24 (15.7%) developed MAEs, either major adverse cardiovascular events (MACE; 8 [5.2%]) or major adverse limb events (MALE; 16 [10.5%]). Baseline demographic characteristics were not significantly different between frailty groups. In contrast, the FI was approximately 30% higher in the group that developed MAEs (mean [SD] score, 0.36 [0.14]) than those who were MAE free (mean [SD] score, 0.26 [0.13]; P = .001), with observed MAE rates of 4 patients (7.5%), 7 patients (12.1%), and 13 patients (31.7%) in the robust, prefrail and frail groups, respectively (P = .004). The FI distinguished individuals who developed MACE and MALE from those who were MAE free (MACE: mean [SD] FI score, 0.38 [0.16]; P = .03; MALE: mean [SD] FI score, 0.35 [0.13]; P = .004) after adjusting by body mass index. In this cohort study, measuring physical frailty using a wrist-worn sensor during a short upper extremity test was a practical method for stratifying the risk of MAEs following revascularization for CLTI when the administration of gait-based tests is often challenging.
Highlights
Frailty is a geriatric syndrome of decreased physiologic reserve and resistance to stressors, which leaves patients more susceptible to poor health outcomes following surgical interventions.[1,2,3,4] recent American College of Surgeons guidelines recommend determining a baseline frailty score for optimal perioperative management of geriatric surgical patients,[5] such scoring is not routinely performed as part of the preoperative assessment in the hospital setting mainly because of the impracticality and inherent limitations of the current screening tools.Frailty is often characterized by assessing physical fitness, called physical frailty
The frailty index (FI) distinguished individuals who developed major adverse cardiovascular events (MACE) and major adverse limb events (MALE) from those who were major adverse event (MAE) free (MACE: mean [SD] FI score, 0.38 [0.16]; P = .03; MALE: mean [SD] FI score, 0.35 [0.13]; P = .004) after adjusting by body mass index. In this cohort study, measuring physical frailty using a wrist-worn sensor during a short upper extremity test was a practical method for stratifying the risk of MAEs following revascularization for chronic limb-threatening ischemia (CLTI) when the administration of gait-based tests is often challenging
To address the limitations of the Fried criteria and the Rockwood FI, we proposed an alternative tool for measuring physical frailty using a wrist-worn sensor called the frailty meter (FM)
Summary
Frailty is a geriatric syndrome of decreased physiologic reserve and resistance to stressors, which leaves patients more susceptible to poor health outcomes following surgical interventions.[1,2,3,4] recent American College of Surgeons guidelines recommend determining a baseline frailty score for optimal perioperative management of geriatric surgical patients,[5] such scoring is not routinely performed as part of the preoperative assessment in the hospital setting mainly because of the impracticality and inherent limitations of the current screening tools.Frailty is often characterized by assessing physical fitness, called physical frailty. The first 3 phenotypes are subjectively assessed with surveys, whereas the last 2 are objectively measured with a grip force test and a 4.5-m walk test. The administration of these tests, the walking test, is challenging in patients with limited mobility, including those with lower extremity peripheral artery disease (PAD) presenting with rest pain, foot ulcers, or amputation.[9] the lack of ability to walk does not necessarily indicate physical frailty and, in addition to incomplete phenotype assessment, compromises the predictive power of the tool.[10,11]
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