The role of Braden scores in predicting outcomes following revascularisation for chronic limb-threatening ischaemia and their association with frailty

Abstract

Introduction: Chronic limb-threatening ischaemia (CLTI) is a substantial healthcare burden associated with high rates of amputation, morbidity and mortality. Frailty measures have proved to be an asset in risk prediction but are not routinely universally collated. This study aimed to identify the utility of Braden scores, an assessment tool for pressure ulceration, as a prognostic indicator for patients with CLTI undergoing revascularisation. Methods: This is a retrospective study of a prospectively maintained database of all patients with CLTI who underwent lower limb revascularisation bypass surgery between 2016 and 2018 in the Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, UK. Their Braden scores were obtained and their electronic Frailty Index (eFI) calculated. Patients were divided into subgroups for each scoring system and their post-revascularisation outcomes were compared. This allowed us to identify the ability of these scoring systems to predict outcomes. Results: Eighty-seven of 124 CLTI patients undergoing lower limb revascularisation bypass surgery had their Braden scores calculated. Nineteen patients (22%) had Braden scores <18 (high risk for ulceration) with a higher risk of baseline sarcopenia (32% vs 12%, p=0.04, OR 1.4, CI 0.48 to 4.53), major amputation (53% vs 28%, p=0.04, OR 1.2, CI 0.48 to 3.02), longer hospital stay (median 33 vs 14 days, p=0.04) and overall complications of pneumonia, myocardial ischaemia and wound infection (58% vs 31%, p=0.035, OR 1.8, CI 0.59 to 5.53) considered as composite factors. These patients also had worse overall survival according to Kaplan–Meier analysis (p<0.001), and the Braden scores were independently associated with death (hazard risk 1.157, CI 0.67 to 1.92; p=0.01). Braden scores were negatively correlated with an increasing eFI (p=0.016). Conclusion: Braden scores appear to be a promising prognostic indicator of adverse outcomes in patients with CLTI undergoing revascularisation surgery. Additionally, Braden scores may also be a surrogate marker of frailty. Further larger studies are required for the validation of Braden scores and their roles in improving outcomes of CLTI intervention.