Association of Frailty Index and Postoperative Outcomes of Open Bypass Lower Extremity Revascularization for Acute Limb Ischemia Using the Vascular Quality Initiative.

Abstract

Frailty in patients undergoing surgery is strongly associated with postoperative complications. The risk analysis index (RAI) is a validated model for frailty that has been shown to predict short and long-term outcomes. Through utilization of the Vascular Quality Initiative (VQI), this study examined the application of the VQI-derived RAI in acute limb ischemia (ALI) patients undergoing open bypass lower extremity revascularization. This is a longitudinal retrospective cohort study conducted on patients undergoing revascularization for ALI from the VQI. Using preoperative variables, an RAI score was calculated for each patient, and they were stratified into six cohorts: ≤20, 21-25, 26-30, 31-35, 35-40, and ≥41. A binary forward multivariate logistic regression was used to determine the risk in each cohort on postoperative outcomes (mortality, amputation, surgical site infection, bypass revision, and discharge destination). The VQI dataset included 3,620 patients (72.1% male) with an average age of 65 ± 12 years. After conducting a binary forward multivariate logistic regression, frailty was not associated with amputation, surgical site infection, or bypass revision. However, frailty at the highest vs lowest RAI score was significantly associated with 3.26 higher times the odds of mortality and 0.32 lower times the odds of being discharged home. Frailty, modeled by the RAI, was demonstrated to be associated with postoperative outcomes in a linear manner in ALI patients undergoing open bypass lower extremity revascularization. Since this is one of the first times a long-term outcomes national database such as the VQI was utilized to study this topic, our research supports the incorporation of the RAI as a screening tool for ALI patients to help guide postoperative care and prognosis and guide shared decision-making in whether to pursue limb salvage or primary amputation.