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Comparative Performance Of Three Frailty Indices In Predicting Postoperative Complications Following Vascular Surgery
Laiba Murad, William Lain, BS, Taylor Washington, BS, Khalid Elhadi, BS, Behzad Farivar, MD FACS, William D. Clouse, MD FACS, Margaret Tracci, MD, JD, FACS.
University of Virginia School of Medicine, Charlottesville, VA, USA.
OBJECTIVES: Frailty is increasingly recognized as a predictor of adverse outcomes after vascular surgery. Preoperative frailty assessments—incorporating measures of physical function, comorbid burden, and functional status—are recommended in major clinical guidelines. However, data comparing how different frailty indices stratify complication risk, particularly across severity levels, remain limited. This study evaluates the association between frailty severity and postoperative complications across three commonly used indices.
METHODS: We conducted a retrospective cohort study of 170 patients who underwent vascular surgery at a single academic center between February 2021 and January 2022. Preoperative physical therapy assessments were used to derive frailty scores using the Short Physical Performance Battery (SPPB), Essential Frailty Toolset (EFT), and Modified Frailty Index (mFI). A composite postoperative complication outcome included ICU admission, in-hospital or operative complications, transfusion, unplanned reoperation, and 30- or 90-day readmission. Multivariable logistic regression models were constructed to adjust for age, sex, and procedure type (open/hybrid vs. endovascular). Each frailty index was analyzed to compare complication rates between patients classified as mildly/moderately frail versus severely frail.
RESULTS: Among the cohort, 29.4% required ICU admission, 47.6% experienced in-hospital complications, 11.2% received transfusions, 7.1% underwent unplanned reoperations, 12.4% were readmitted within 30 days, and 0.6% died within 30 days. Open/hybrid procedures were associated with significantly higher odds of postoperative complications (aOR 5.58; 95% CI: 1.83-17.04; p=0.003). Neither age (p=0.197) nor sex (p=0.896) were significant predictors. After adjustment, severe frailty was not independently associated with increased complication risk in any index: SPPB (aOR 1.24; p=0.600), EFT (aOR 1.40; p=0.554), or mFI (aOR 0.95; p=0.875).
CONCLUSIONS:In this cohort, frailty severity measured by three widely used indices was not independently predictive of postoperative complications after vascular surgery. Procedure type—specifically open or hybrid interventions—was the strongest determinant of adverse outcomes. These findings suggest that while frailty screening remains valuable for holistic patient assessment, its utility in predicting postoperative complications may be limited without considering procedural risk. Additionally, the lack of association may reflect enhanced perioperative support for frailer patients or limitations in current frailty tools. Further research is needed to refine frailty-based risk stratification in vascular surgical populations.
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