Modified frailty index as an indicator for outcomes after lower extremity endovascular revascularization

The 5-factor frailty index is associated with adverse outcomes after various procedures. This study aimed to evaluate the performance of the 5-factor frailty index after lower extremity endovascular revascularization. The American College of Surgeons’ National Surgical Quality Improvement Program Da...

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Bibliographic Details
Published in:Surgery 2023-03, Vol.173 (3), p.837-845
Main Authors: Balasundaram, Naveen, Kanake, Shubham, Thaghalli Sunil Kumar, Vishruth, Chandra, Isaiah, Schlesselman, Chase, Vogel, Todd R.
Format: Article
Language:English
Subjects:
Aged
Chronic Limb-Threatening Ischemia
Endovascular Procedures - adverse effects
Female
Frailty - complications
Frailty - diagnosis
Humans
Ischemia
Lower Extremity - blood supply
Lower Extremity - surgery
Male
Peripheral Arterial Disease - surgery
Retrospective Studies
Risk Assessment
Risk Factors
Treatment Outcome
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Summary:The 5-factor frailty index is associated with adverse outcomes after various procedures. This study aimed to evaluate the performance of the 5-factor frailty index after lower extremity endovascular revascularization. The American College of Surgeons’ National Surgical Quality Improvement Program Database as retrospectively analyzed for patients undergoing lower extremity endovascular revascularization between 2015 and 2019. Outcomes were assessed using bivariate analyses and multivariate logistic regression analyses. In the study, 11,947 lower extremity endovascular revascularization performed between 2015 and 2019 were identified from National Surgical Quality Improvement Program Database. Median age was 69 (standard deviation 11.44) years, 4,727 (39.6%) were female, and 7,570 (63.4%) were White. In addition, 7,541 (62.9%) were performed for chronic limb threatening ischemia. Thirty-day mortality was 1.7%. Bivariate analysis demonstrated that a 5-factor frailty index score greater than 0.6 was associated with higher rates of discharge to SNF (28.6% vs 8.2%, P < .001, reference 5-factor frailty index = 0), cardiopulmonary arrest (2.0% vs 0.1%, P < .001), readmission (21.1% vs 10.8%, P < .001), reintubation (2.8% vs 0.3%, P < .001), and 30-day mortality (5.1% vs 0.7%, P < .001). Beta blocker use, higher age, chronic limb threatening ischemia indication, and 5-factor frailty index were all associated with increased 30-day mortality. Multivariate logistic regression showed that 5-factor frailty index >0.6 predicted 3 times higher odds for 30-day mortality (odds ratio, 2.988; P = .013), with physiologic high risk (odds ratio, 2.118; P < .001), chronic limb threatening ischemia indication (odds ratio, 2.157; P < .001), and inpatient procedures (odds ratio, 3.409; P < .001) also showing increased risk for mortality. For patients undergoing lower extremity endovascular revascularization, higher 5-factor frailty index was associated with increased hospital resource utilization and 30-day mortality. The 5-factor frailty index may be useful for preoperative risk stratification and predicting adverse outcomes in patients undergoing lower extremity endovascular revascularization.
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2022.09.018