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. 2021 Jun;73(6):2132-2139.e2.
doi: 10.1016/j.jvs.2020.10.088. Epub 2020 Dec 31.

Frailty leads to poor long-term survival in patients undergoing elective vascular surgery

Louise B D Banning  1 , Mostafa El Moumni  2 , Linda Visser  1 , Barbara L van Leeuwen  3 , Clark J Zeebregts  1 , Robert A Pol  4
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Free article

Frailty leads to poor long-term survival in patients undergoing elective vascular surgery

Louise B D Banning et al. J Vasc Surg. 2021 Jun.
Free article

Abstract

Objective: Frailty has persistently been associated with unfavorable short-term outcomes after vascular surgery, including an increased complication risk, greater readmission rate, and greater short-term mortality. However, a knowledge gap remains concerning the association between preoperative frailty and long-term mortality. In the present study, we aimed to determine this association in elective vascular surgery patients.

Methods: The present study was a part of a large prospective cohort study initiated in 2010 in our tertiary referral teaching hospital to study frailty in elderly elective vascular surgery patients (Vascular Ageing Study). A total of 639 patients with a minimal follow-up of 5 years, who had been treated from 2010 to 2014, were included in the present study. The Groningen Frailty Indicator, a 15-item self-administered questionnaire, was used to determine the presence and degree of frailty.

Results: Of the 639 patients, 183 (28.6%) were considered frail preoperatively. For the frail patients, the actuarial survival after 1, 3, and 5 years was 81.4%, 66.7%, and 55.7%, respectively. For the nonfrail patients, the corresponding survival was 93.6%, 83.3%, and 75.2% (log-rank test, P < .001). Frail patients had a significantly greater risk of 5-year mortality (unadjusted hazard ratio, 2.09; 95% confidence interval, 1.572-2.771; P < .001). After adjusting for surgical- and patient-related risk factors, the hazard ratio was 1.68 (95% confidence interval, 1.231-2.286; P = .001).

Conclusions: The results of our study have shown that preoperative frailty is associated with significantly increased long-term mortality after elective vascular surgery. Knowledge of a patient's preoperative frailty state could, therefore, be helpful in shared decision-making, because it provides more information about the procedural benefits and risks.

Keywords: Frail elderly; Frailty; Mortality; Vascular surgical procedure.

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