PC086. The Prognostic Implications of Diagnosing Frailty and Sarcopenia in Vascular Surgery Practice

Abstract

Frailty and sarcopenia are two related but independent conditions commonly diagnosed in older patients that can be used to predict an individual's ability to tolerate the stress of major vascular surgery. For surgical decision making, however, it is also important to know the prognostic implications associated with these conditions and estimate whether patients will live long enough to benefit from elective procedures. The objective of this study was to assess long-term survival among nonsurgical patients diagnosed with frailty and sarcopenia within an outpatient vascular surgery clinic setting. We retrospectively reviewed all patients who presented to the vascular surgery clinic at a single academic hospital between December 2015 and August 2017 who did not subsequently undergo surgery. All patients underwent prospective frailty assessment during their clinic visit using the Clinical Frailty Scale. Patients who underwent an abdominal computed tomography scan within the prior 12 months were included in the analysis. A single axial CT-image at the most caudal end of the third lumbar vertebrae was assessed to measure cross-sectional areas (in centimeters squared) of skeletal muscle, and sarcopenia was defined using established criteria of <52.4 cm2/m2 for male and <38.5 cm2/m2 for female patients. After stratifying patients by frailty and sarcopenia diagnoses, the association with all-cause mortality was analyzed using Kaplan-Meier curves and log-rank tests. A total of 248 patients were identified, of which 48 (19%) were diagnosed as frail and 98 (40%) met CT diagnostic criteria for sarcopenia. The median follow-up after CT imaging was 1.5 years (interquartile range, 1.1-2.2 years). When further stratified, 72 patients (29%) met only sarcopenia criteria, 22 (9%) met only frailty criteria, and 26 (11%) met criteria for both sarcopenia and frailty. Patients diagnosed with either sarcopenia or frailty were older (mean, 67 years vs 60 years; P < .001) and more likely to be male (57% vs 36%; P < .001) and have chronic obstructive pulmonary disease (67% vs 45%; P = .013). When compared with patients without sarcopenia or frailty, long-term survival was significantly decreased for patients diagnosed with either sarcopenia or frailty (Fig; log-rank test P < .01). However, patients diagnosed with both sarcopenia and frailty were found to have the highest mortality rate at the 1-year follow-up. Frailty and sarcopenia are common conditions among patients presenting to outpatient vascular surgery clinics that can be used to predict long-term patient survival. Identifying patients with both frailty and sarcopenia portends the worst survival, and should be taken into consideration when deciding whether to proceed with elective vascular surgery procedures.