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. 2022 Sep;92(9):2305-2311.
doi: 10.1111/ans.17810. Epub 2022 Jun 8.

Frail patients having vascular surgery during the early COVID-19 pandemic experienced high rates of adverse perioperative events and amputation

Australian and New Zealand Vascular Trial Network (ANZVTN); Sarah J Aitken  1 , Bernard Allard  2 , Nishath Altaf  3 , Noel Atkinson  4 , Omar Aziz  5 , Ruth Battersby  6 , Ruth Benson  7 , Jennifer L Chambers  8 , Gabriella Charlton  1 , Chloe Coleman  9 , Joseph A Dawson  6 , Anastasia Dean  9 , Bedanta S Dhal  10 , Robert Fitridge  6 , John Gan  8 , Joseph Hanna  3 , Andrew T Hattam  4 , Martin Hein  3 , Kay Hon  6 , Samantha Khoo  1 , Joseph Kilby  11 , Beatrice Kuang  6 , Kai Wen Leong  4 , Eunice Lim  1 , Ju-Wei N Liu  1 , David N McClure  11 , Shreya Mehta  1 , Jana-Lee Moss  10 , Juanita Muller  12 , Korana Musicki  4 , Sandip Nandhra  7 , Michael J Papanikolas  1 , Fernando Picazo Pineda  3 , Franklin Pond  2 , Nandhini Ravintharan  9 , Toby Richards  10 , Hani Saeed  2 , Christopher N Selvaraj  8 , Gurkirat Singh  5 , Yogeesan Sivakumaran  6 , Bethany M Stavert  1 , Elizabeth Suthers  8 , Robert Tang  5 , Vincent C Varley  9 , Thodur M Vasudevan  9 , Uyen G Vo  10 , Timothy Wagner  4 , Judy Wang  11 , Jackie Wong  3
Affiliations

Frail patients having vascular surgery during the early COVID-19 pandemic experienced high rates of adverse perioperative events and amputation

Australian and New Zealand Vascular Trial Network (ANZVTN) et al. ANZ J Surg. 2022 Sep.

Abstract

Background: Frailty predicts adverse perioperative outcomes and increased mortality in patients having vascular surgery. Frailty assessment is a potential tool to inform resource allocation, and shared decision-making about vascular surgery in the resource constrained COVID-19 pandemic environment. This cohort study describes the prevalence of frailty in patients having vascular surgery and the association between frailty, mortality and perioperative outcomes.

Methods: The COVID-19 Vascular Service in Australia (COVER-AU) prospective cohort study evaluates 30-day and six-month outcomes for consecutive patients having vascular surgery in 11 Australian vascular units, March-July 2020. The primary outcome was mortality, with secondary outcomes procedure-related outcomes and hospital utilization. Frailty was assessed using the nine-point visual Clinical Frailty Score, scores of 5 or more considered frail.

Results: Of the 917 patients enrolled, 203 were frail (22.1%). The 30 day and 6 month mortality was 2.0% (n = 20) and 5.9% (n = 35) respectively with no significant difference between frail and non-frail patients (OR 1.68, 95%CI 0.79-3.54). However, frail patients stayed longer in hospital, had more perioperative complications, and were more likely to be readmitted or have a reoperation when compared to non-frail patients. At 6 months, frail patients had twice the odds of major amputation compared to non-frail patients, after adjustment (OR 2.01; 95% CI 1.17-3.78), driven by a high rate of amputation during the period of reduced surgical activity.

Conclusion: Our findings highlight that older, frail patients, experience potentially preventable adverse outcomes and there is a need for targeted interventions to optimize care, especially in times of healthcare stress.

Keywords: COVID-19; amputation; frailty; vascular surgery procedures.

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Conflict of interest statement

The authors have no financial or personal conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Enrolment and follow up for patients enrolled in the COVER‐AU study. *CFS, Clinical Frailty Score.
See this image and copyright information in PMC

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