Using The Risk Analysis Index To Assess Frailty In Veteran Cohort Undergoing Endovascular Aortic Aneurysm Repair
Wayne Tse, MD, Kedar S. Lavingia, MD, Michael Amendola, MD, MEHP.
Virginia Commonwealth University, Richmond, VA, USA.
OBJECTIVES: Surgical frailty is strongly associated with increased perioperative morbidity and mortality. The Risk Analysis Index (RAI) is a validated frailty score system that has been shown to predict short-term outcomes and long-term mortality in various surgical subspecialties. This study applies the frailty score to the veteran aneurysm population.
METHODS: After obtaining IRB approval, Veteran Affairs Surgical Quality Improvement Program (VASQIP) data was queried for endovascular repair of intrarenal abdominal aortic aneurysm or dissection (EVAR) CPT codes (34800, 34803, and 34805). Pre-operative variables were used to calculate a RAI score. Patients were placed into three cohorts based on RAI score (non-frail: ≤20, frail: 21-34, very frail: ≥35). Χ2 test and ANOVA test were used compare cohorts. Forward logistic regression modeling was used to determine risks of each cohort.
RESULTS: Between 2001 and 2018, 5,878 patients underwent EVAR. 99.5% of patients were male with an average age of 71 ± 8 years. The cohorts contained 36.2% (n=2,129), 56.0% (n=3,294) and 7.7% (n=455) for the non-frail (RAI ≤24), frail (RAI=25-34) and very-frail (RAI≥35) respectively. Frailty was associated with increased rates of cardiac, pulmonary, renal, and overall complications, death, and increased length of stay (Table I). 
When risk adjusted, frailty was associated with up to 3.2 times as likely to have any complication and up to 7.3 times as likely to perish within 30 days. (Table II). 
Emergent surgery was associated with an OR for mortality of 14.2 (CI=7.9-25.7; p<0.001) and complication OR of 4.1 (CI=2.8-5.9;<0.001).
CONCLUSIONS: Frailty as determined by Risk Analysis Index was associated with post-operative outcomes in a dose-dependent manner. Frailty was associated with higher rates of major cardiac (MI, cardiac arrest), pulmonary (pneumonia, failure to wean vent, reintubation), renal (renal insufficiency, renal failure), overall complications, and death. We recommend the use of this frailty index as a screening tool to guide discussions with patients undergoing endovascular aortic aneurysm repair.
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