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Frailty is a Poor Predictor of One-year Mortality and Morbidity after Ruptured Abdominal Aortic Aneurysm Repair
Moira McGevna1, Lily S.F. Adler1, Saum A. Rahimi, MD2, William E. Beckerman, MD2.
1Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA, 2Department of Surgery, Division of Vascular and Endovascular Therapy, RWJMS, NEW BRUNSWICK, NJ, USA.

OBJECTIVES: Previous research has shown that frailty status does not correlate with 30-day outcomes after repair of a ruptured abdominal aortic aneurysm (rAAA). However, there are no studies to date investigating whether frailty is associated with longer-term mortality and morbidity after rAAA repair. The aim of this study is to evaluate whether frailty can be used as a risk assessment tool for predicting one-year mortality and morbidity in patients undergoing both open and endovascular rAAA repair.
METHODS: We conducted a retrospective analysis of patients undergoing rAAA repair at a single tertiary care center from January 2011 to November 2022. Frailty was assessed for each patient using the modified frailty index (mFI), a validated frailty metric based on the Canadian Study of Health and Aging and was defined as an mFI ≥0.27. The primary outcome was one-year mortality. Logistic regression and receiver operating characteristic (ROC) curves were used to assess mFI-11 with one-year morbidity and mortality. Kaplan-Meier analysis was used to compare rates of survival. Categorical and continuous data were compared using χ2 and Studentís t-tests, respectively. For all tests, a P-value of <0.05 is considered statistically significant.
RESULTS:Seventy-eight patients were identified during the study period (35 frail vs. 43 non-frail) with a median follow up of 7 months (5.9 months frail vs. 10 months non-frail) and a one-year mortality rate of 40% overall (49% frail vs. 33% non-frail, P= 0.86). Logistic regression analysis showed no correlation between frailty and reintervention (odds ratio 1.6 [95% confidence interval 0.1-27.6], P=0.75), dialysis dependence (0.8 [0.1-9.2], P=0.83), home oxygen use (1.6 [0.2-13.0], P=0.6), and dependent mobility (0.8 [0.12-4.7], P=0.79). The area under the ROC curve (AUC) for mFI-11 was 0.58 for one-year mortality (P=0.2). Kaplan Meier analysis showed no difference in rates of survival between frail and non-frail patients (P=0.052) (Figure 1).
CONCLUSIONS:Frailty, defined using the modified frailty index, was not predictive of one-year outcomes after open or endovascular rAAA repair. Other metrics are needed to more accurately assess long term risk to enable better patient and family counseling after repair of rAAA.


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