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Objectives
Frailty index has been linked to adverse outcomes after operative procedures. In this study, we evaluated the association between frailty index and outcomes after lower extremity bypass (LEB) for lower extremity ischemia.
Methods
The American College of Surgeons-National Surgical Quality Improvement (ACS-NSQIP) dataset (2005-2012) was used to identify patients who underwent elective LEB using diagnostic and procedure CPT codes. Modified frailty index (mFI), derived from the Canadian Study of Health and Aging, was categorized into three groups. Association of mFI with postoperative 30-day mortality (POD) and myocardial infarction (MI), deep tissue surgical site infection (SSI) and graft failure (GF) was evaluated. The independent effect of frailty on these outcomes was assessed by multivariate regression analysis adjusting for age (dichotomized by <70 or ≥70), gender, American Society of Anesthesiology (ASA) class, body mass index (BMI), and creatinine levels.
Results
We identified 13,033 patients who underwent LEB with the outcome of interest ranging from 1.3% (POD, MI) to 3.1% (GF). 2.2% of patients presented with SSI. .The mean of mFI of the entire sample was 0.3±0.1 which was significantly lower than that of the group with any morbidity or POD (0.4±0.1; p<0.001). Both univariate and multivariate analyses of association revealed that higher mFI was associated with increased odds of MI, SSI and GF. Multivariate analysis did not show a significant association between higher mFI and POD (Figure). Female gender, age above 70, BMI>30 and elevated creatinine independently predicted POD in this patient population.
Conclusion:
Higher mFI is independently associated with myocardial infarction (MI), Surgical Site Infection (SSI) and Graft Failure (GF), but not POD. mFI should be considered as a variable for risk -adjusted evaluation of outcomes.