Preoperative Frailty Assessment Predicts Loss of Independence Following Vascular Surgery

Abstract

Frailty is a clinical syndrome associated with loss of metabolic reserves that is prevalent among patients who present to vascular surgery clinics for evaluation. The clinical frailty scale (CFS) is a rapid assessment method shown to be highly specific for identifying frail patients. In this study, we sought to evaluate whether the preoperative CFS score could be used to predict loss of independence after major vascular procedures. We identified all patients living independently at home that were prospectively assessed using the CFS before undergoing an elective major vascular surgery procedure (admitted for more than 24 hours) at an academic medical center between January 2016 and January 2017. Patient and procedure-level data were obtained from our institutional Vascular Quality Initiative registry database. The composite outcome of discharge to a skilled nursing facility or 30-day mortality was evaluated using bivariate and multivariate regression models. The CFS was used to assess 75 independent patients before undergoing elective open abdominal aortic aneurysm repair (9%), endovascular aneurysm repair (17%), thoracic endovascular aortic repair (4%), suprainguinal bypass (8%), infrainguinal bypass (19%), carotid endarterectomy (13%), or a peripheral vascular intervention (29%). Among 21 individuals (28%) categorized as being frail using the CFS, there was no significant difference in age, gender, or hospital length of stay (6 days frail vs 4 days nonfrail; P = .15) compared to nonfrail patients. However, frail patients were significantly more likely to need mobility assistance after surgery (67% frail vs 25% nonfrail; P < .01) and to be discharged to a nursing facility or die within 30 days after surgery (33% frail vs 9% nonfrail; P = .01). Preoperative frailty was associated with an over fourfold higher risk (odds ratio, 4.8; 95% confidence interval, 1.1-20.7; P < .05) of 30-day mortality or loss of independence, independent of the vascular procedure undertaken. The CFS is a practical tool for assessing preoperative frailty among patients undergoing elective major vascular surgery and can be used to predict the likelihood of requiring discharge to a nursing facility after surgery. The identification of frail patients before major surgery can help to manage postoperative expectations and optimize transitions of care.