Modified Frailty Index Can Predict Hospital Resource Use after Elective Aortoiliac Endovascular Intervention

Abstract

Introduction: The 5-factor frailty index (mFI-5) has been reliably used to predict surgical outcomes. This study was to evaluate performance of mFI-5 after elective Aortoiliac endovascular intervention (eAIER). Methods: The American College of Surgeons’ National Surgical Quality Improvement Program Database (NSQIP) was retrospectively analyzed for patients undergoing eAIER between 2015 and 2020. Outcomes were assessed using univariate analysis (Mann-Whitney, Kendall Tau-b, Chi-square and Cochran-Armitage test) and multivariate logistic regression analysis. Results: 3604 eAIER were performed on patients with median age 67 (SD 10.19) years. 30-day mortality was 0.8%. Univariate analysis demonstrated that mFI-5>0.6 was associated with higher rates of prolonged hospital stay (6.2% vs 2.1%, p = 0.026, reference mFI-5=0), readmission (15.1% vs 4.7%, p < 0.001), reoperation (7.1% vs 4.7%, p =0.01), 30-day mortality (3.8 % vs 0.2%, p < 0.001) and reintubation (1.9% vs 0.2%, p = 0.014). Beta blocker use, “physiological high risk”, Chronic Limb threatening ischemia, Ankle brachial index<0.4 and mFI-5 were all associated with readmission. Multivariate logistic regression showed that mFI-5 remained as a significant predictor with mFI-5>0.6 predicting a more than twice higher odds for readmission (Odds ratio OR 2.60, p = 0.001), with physiological high risk (OR 2.18, p <0.001) and CLTI Indication (OR 1.62, p < 0.001) also predisposing to readmission Conclusion: For patients undergoing eAIER, higher mFI-5 was associated with increased resource use, with increased risk for prolonged hospital stay, reoperation and readmission. The mFI-5 can help identify patients at high risk for inferior outcomes and may help in preoperative risk stratification and resource planning