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Impact Of Frailty On Outcomes Of Venous Ulcer Interventions
Mark G. Davies, MD PhD MBA
1, Joseph P. Hart, MD MHL
2.
1Ascension Health, Waco, TX, USA,
2MCW, Milwaukee, WI, USA.
Objective: Lower extremity ulceration is an increasing problem. Up to 1% of patients with chronic venous disease present with a primary venous Leg Ulcer (VLU). Frailty are common findings among these patients. This study aimed to analyze the impact of frailty on the outcomes of patients undergoing treatment for VLU.
Methods: Between 2012 and 2022, all patients presenting with a potential VLU were analyzed. Inclusion criteria were all patients with a primary active VLU, in the presence of superficial truncal venous incompetence (long saphenous vein - LSV; short saphenous vein - SSV and perforator - PERF) and without total deep venous incompetence on duplex imaging.Frailty was assessed by the Simple Vascular Quality Initiative-Frailty Score (sVQI-FS; congestive heart failure, renal impairment, chronic obstructive pulmonary disease, not living at home, not ambulatory, anemia, and underweight status). A sVQI-FS score of 0.3 or greater was considered frail. Demographics and interventions to effect healing were recorded. The primary outcomes were ulcer healing at 24 weeks and recurrence within one year.
Results: 819 patients (47% male, age 64 ± 11 years, mean ± SD) presented with an active VLU to the wound care center and/or vascular clinic. 31% had their ulcer for
>12 months. Of these, common comorbidities included obesity (62%), cardiac disease (35%), diabetes (31%), a history of deep vein thrombosis (DVT) (23%) and varicose veins (45%). Studies demonstrated that 78% had LSV incompetence, 33% had SSV incompetence, and 11% had perforator incompetence. 43% of the patients were considered frail. Frail patients were more likely to have an ulcer longer and a longer interval before referral than non-frail patients. The presence of frailty resulted in longer healing times and increased recurrence of the VLU (Table 1).
| | | |
| Table 1 Outcomes | | | |
| sVQI-FS | Non-Frail | Frail | P-Value |
| Patients (n) | 450 | 369 | |
| Charlson Comorbidityy index >3 | 51% | 76% | 0.01 |
| Ulcer Healing @ 24 weeks | 71% | 50% | 0.01 |
| Recurrence @ 1 yr | 26% | 31% | 0.05 |
Conclusions: Frailty significantly affects early referral for care and impacts healing and recurrence rates. Frailty significantly affects early referral for care and impacts healing and recurrence rates. Intervening to ameliorate frailty is an opportunity to enhance advanced venous ulcer care.
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