Frailty Is A Poor Predictor Of Postoperative Morbidity And Mortality After Ruptured Abdominal Aortic Aneurysm
Michael Ciaramella, Timothy Kravchenko, Anthony Grieff, MD, ShihYau Huang, MD, MS, Saum Rahimi, MD, William Beckerman, MD.
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
OBJECTIVES: Frailty has gained prominence as a predictor of postoperative outcomes across a number of surgical specialties, vascular surgery included. The role of frailty is less defined in acute surgical settings. We assessed the prognostic value of frailty for patients undergoing surgery for a ruptured abdominal aortic aneurysm (rAAA).
METHODS: A single-institution retrospective chart review of all patients undergoing surgery for rAAA between January 1, 2011 and November 27, 2019 was performed. Frailty was assessed using the modified frailty index (mFI), a validated frailty metric based on the Canadian Study of Health and Aging. Frailty was defined as an mFI ≥0.27. Performance of the mFI was compared to that of the Vascular Study Group of New England (VSGNE) rAAA mortality risk score. Chi square, Fisher’s exact, and t tests, were used to evaluate for associations between frailty and 30-day postoperative outcomes. Univariate and multivariate logistic regression were used to obtain odds ratios for in-hospital mortality. A receiver operating characteristic (ROC) curve was generated to compare the predictive value of the mFI and VSGNE score for in-hospital mortality.
RESULTS: Sixty patients were identified during the study period with an in-hospital mortality rate of 37%. Twenty-one patients were deemed frail by mFI, including all patients with known myocardial infarction, stroke with a neurologic deficit or dependent functional status. In-hospital mortality did not differ significantly based on frailty status (33% non-frail vs. 43% frail, p=0.47). Frailty status was not significantly different for patients with acute kidney injury (10% non-frail vs. 10% frail), prolonged intubation (13% vs. 5%), abdominal compartment syndrome (8% vs. 10%), and Type I or Type III endoleak (8% vs. 19%). On multivariate analysis controlling for systolic blood pressure <70 mm Hg, suprarenal aortic control, and creatinine >2.0 mg/dl, the mFI produced an adjusted odds ratio (aOR) of 0.7 (95% confidence interval [CI]: 0.2-3.0). The ROC curve for the mFI produced an area under the curve (AUC) of 0.55 (p=0.55) for in-hospital mortality while that of the VSGNE score produced an AUC of 0.69 (p=0.02).
CONCLUSIONS: The mFI did not significantly predict 30-day outcomes after rAAA in this cohort. This suggests that the baseline health status of a patient with rAAA may play a less significant role in their postoperative prognosis than their acuity on presentation.
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