Functional Decline Among Frail Patients After Vascular Surgery

Abstract

Frailty is a clinical syndrome that has been associated with slow recovery and loss of independence after vascular surgery. However, the degree of functional impairment that frail patients experience after surgery is unclear. The objective of this study was to prospectively measure changes in functional status among frail patients undergoing both minor and major vascular procedures. We prospectively identified a sample of patients who had consented to undergo elective vascular surgery procedures at an academic medical center between May 2018 and March 2019. Before surgery, all patients underwent a provider assessment of frailty using the Clinical Frailty Scale as well as patient-reported functional status using the Lawton instrumental activities of daily living (iADLs) scale and the Katz activities of daily living (ADLs) index. After surgery, these same assessments were used to evaluate each patient’s functional status at 2-week and 1-month follow-up time points. Changes in iADL and ADL indices among frail and nonfrail patients were compared using paired t-tests and multivariate regression models. A total of 139 patients were assessed before and after minor (55%) and major (45%) surgical procedures; 35% of patients (48) were considered frail before surgery using the validated Clinical Frailty Scale. On average, frail patients were older (65 years frail vs 58 years nonfrail; P < .05) and more likely to have multiple medical comorbidities including chronic kidney disease, chronic obstructive pulmonary disease, and diabetes (P < .05). After surgery, frail patients were more likely to have complications (29.2% vs 14.4% nonfrail; P < .05) and experienced longer hospital stays (7.1 days vs 2.4 days; P < .001). Compared with nonfrail patients, frail patients had significantly lower functional status (iADL and ADL) scores at baseline before surgery and experienced a greater decline in ability to independently complete iADLs and ADLs at 2 weeks and 1 month after surgery (Fig 1 and Fig 2, respectively). In logistic regression models, frailty was associated with an increased likelihood of decline in iADLs (odds ratio, 5.7; 95% confidence interval, 2.1-15.6; P < .01) and ADLs (odds ratio, 8.2; 95% confidence interval, 1.9-35.1; P < .01) at 1 month after surgery after controlling for procedure type and medical comorbidities. Frail patients experience a significant decline in ability to perform ADLs and iADLs that persists at 1 month after surgery. These data highlight the importance of counseling frail patients and their caregivers about functional impairment that occurs after vascular surgery and employing strategies to help mitigate loss of independence.Fig 2Katz ADL function.View Large Image Figure ViewerDownload Hi-res image Download (PPT)