ORIGINAL ARTICLE  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2022 December;63(6):716-23

DOI: 10.23736/S0021-9509.22.11895-1

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Frailty predicts poor longer-term outcomes in patients following lower limb open surgical revascularization

Asanish KALYANASUNDARAM, Matthew CHOY, Alekhya KOTTA, Lukasz P. ZIELINSKI, Patrick A. COUGHLIN ✉

Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

BACKGROUND: Frailty in vascular surgery patients is increasingly recognized as a marker of poor outcome. This provides particular challenges for patients with lower limb peripheral arterial disease who require surgical revascularization. This study aimed to assess the impact of frailty on short- and long-term outcome in this specific patient group using a specialty specific frailty score.
METHODS: Patients undergoing open surgical revascularization for chronic limb ischemia (January 2015-December 2016) were assessed. Demographics, mode of admission, diagnosis, and site of surgery were recorded alongside a variety of frailty-specific characteristics. We calculated the previously validated Addenbrookes Vascular Frailty Score (AVFS) and Long AVFS (LAVFS). Primary outcome was 3-year mortality.
RESULTS: Two hundred and sixty-one patients (75% men, median age 69 years) were studied. The median length of stay was 6 days with a 3-year mortality of 23%. The predictive power of vascular frailty scores showed that for 3-year mortality, area under the receiver operator curve values (AUROC) were specific for both the AVFS score (AUROC: 0.724, 95% CI: 0.654-0.794) and LAVFS Score (AUROC: 0.741, 95%CI: 0.670-0.813). Furthermore, the cumulative AVFS and LAVFS scores both predicted mortality over the follow-up period (P=0.0001) with increased mortality among patients with higher scores.
CONCLUSIONS: Incremental worsening of frailty, determined using a specialty specific frailty score, predicts mortality risk in patients undergoing lower limb surgical revascularization.

KEY WORDS: Lower extremity; Ischemia; Frailty; Mortality