A systematic review of frailty assessment tools used in vascular surgery research

Welsh, Silje; Pearson, Richard; Hussey, Keith; Brittenden, Julie; Orr, Douglas J.; Quinn, Terence J.

doi:10.1016/j.jvs.2023.06.010

Cited by 10 publications

(9 citation statements)

References 178 publications

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“…However, the CFS scale shows a good psychometric property, a short assessment time, and does not require additional equipments. At present, there is evidence that the CFS scale tool is suitable for the assessment of cardiovascular disease patients, which can be further verified in the future ( 53 ). In addition, many studies define the evaluation results as binary cut-off, but the development of frailty is a dynamic process, and data analysis should reflect this continuity ( 54 ).…”

Section: Discussionmentioning

confidence: 94%

Prevalence and adverse outcomes of pre-operative frailty in patients undergoing carotid artery revascularization: a meta-analysis

Liu,

Yao,

Zhang

et al. 2023

Front. Cardiovasc. Med.

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IntroductionFrailty can lead to a decrease in the patient's resistance to interference such as injury and disease, and cause a series of complications. An increasing number of studies have found that pre-operative frailty exacerbates the occurrence of adverse events after carotid artery revascularization, but an integrated quantitative analysis is currently lacking. Therefore, we conducted a meta-analysis to evaluate the impact of pre-operative frailty on patients undergoing carotid artery revascularization.MethodAccording to the PRISMA guidelines, we systematically searched for relevant studies on Medline, Embase, Ovid, CINAHL, Web Of Science, and Cochrane Library from establishment until June 2023. Summarize the risk of adverse outcome events through OR and 95% CI.ResultsA total of 16 cohort studies were included, including 1692338 patients. Among patients who underwent carotid artery revascularization surgery, the prevalence of pre-operative frailty was 36% (95% CI = 0.18–0.53, P < 0.001). Compared with non frail individuals, frail individuals have an increased risk of mortality (OR = 2.35, 95% CI = 1.40–3.92, P = 0.001, I2 = 94%), stroke (OR = 1.33, 95% CI = 1.10–1.61, P = 0.003, I2 = 71%), myocardial infarction (OR = 1.86, 95% CI = 1.51–2.30, P < 0.001, I2 = 61%), and non-home discharge (OR = 2.39, 95% CI = 1.85–3.09, P < 0.001, I2 = 63%).ConclusionThe results of this article show that patients undergoing carotid artery revascularization have a higher prevalence of pre-operative frailty, which can lead to an increased risk of postoperative death, stroke, myocardial infarction, and non-home discharge. Strengthening the assessment and management of frailty is of great significance for patient prognosis.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=416234, identifier: CRD42023416234.

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Section: Discussionmentioning

confidence: 94%

Prevalence and adverse outcomes of pre-operative frailty in patients undergoing carotid artery revascularization: a meta-analysis

Liu,

Yao,

Zhang

et al. 2023

Front. Cardiovasc. Med.

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“…Within vascular surgery, the CFS and mFI-11 are the most commonly used tools, demonstrating international familiarity. 2 By continuing their use, the research impact of this study is enhanced. A primary criterion was that the selected tools should not require additional equipment, external training or have copyright restrictions.…”

Section: Methods and Analysismentioning

confidence: 96%

“… 1 Frailty is common in vascular patients with an estimated prevalence three times that of the general population. 2 An association between the clinical syndrome of frailty and adverse surgical outcomes in vascular surgery has been described. 1 For the person living with frailty, adaptations to the traditional surgical approach may be necessary on an individual and wider service model level to improve healthcare outcomes, ensure equity in healthcare delivery and guide resource allocation.…”

Section: Introductionmentioning

confidence: 99%

“…Our previous research demonstrates an evidence gap around the ability to identify a preferred approach to frailty assessment in the vascular surgical context. 2 Limitations of studies to date include potential biases from retrospective design, poor generalisability to the UK National Health Service (NHS), lack of head to head comparisons of tools and limited assessment of properties such as feasibility and acceptability.…”

Section: Introductionmentioning

confidence: 99%

Section: Introduction Background and Rationalementioning

confidence: 99%

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Frailty Assessment in Vascular OUtpatients Review (FAVOUR) protocol: single-centre prospective cohort study comparing feasibility and prognostic value of commonly used frailty assessment tools

Welsh,

Hussey,

Brittenden

et al. 2023

BMJ Open

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IntroductionFrailty has consistently demonstrated associations with poorer healthcare outcomes. Vascular guidelines have recognised the importance of frailty assessment. However, an abundance of frailty tools and a lack of prospective studies confirming suitability of routine frailty assessment in clinical practice has delayed the uptake of these guidelines. The Frailty Assessment in Vascular OUtpatients Review study speaks to this evidence gap. The primary aim is to assess feasibility of implementing routine frailty assessment in a reproducible outpatient setting. Secondary objectives include comparing prognostic values and interuser agreement across five frailty assessment tools.Methods and analysisThis single-centre prospective cohort study of feasibility is conducted in a rapid-referral vascular surgery clinic, serving a population of 2 million. Adults with capacity (>18 years), attending a clinic for any reason, are eligible for inclusion. Five assessments are completed by patient (Rockwood Clinical Frailty Scale (CFS) and Frail NonDisabled Questionnaire), clinician (CFS, Healthcare Improvement Scotland FRAIL tool and ‘Initial Clinical Evaluation’) and researcher (11-item modified Frailty Index). Consistent with feasibility objectives, outcome measures include recruitment rates, frailty assessment completion rates, time-to-complete assessments and interuser variability. Electronic follow-up at 30 days and 1 year will assess home-time and mortality as prognostic indicators. Patients treated surgically/endovascularly will undergo additional 30-day and 1-year postoperative follow-up, outcome measures include: surgical procedure, mortality, complications (according to Clavien-Dindo Classification), length of stay, readmission rates, non-home discharge, home-time, higher social care requirements on discharge and amputation-free survival. Prognostic value will be compared by area under receiver operating characteristic curves. Continuous outcome variables will be analysed using Spearman’s rank correlation coefficient. Interuser agreement will be compared by percentage agreement in Cohen’s kappa coefficient. Ethics and disseminationThe study is sponsored by National Health Service Greater Glasgow and Clyde (R&IUGN23CE014). London-Riverside REC (23/PR/0062) granted ethical approval. Results will be disseminated through publication in peer-reviewed vascular surgery and geriatric medicine themed journals and presentation at similar scientific conferences.Trials registration numberNCT06040658. Stage of study: pre-results.

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Prediction of postoperative mortality in older surgical patients by clinical frailty scale: A systematic review and meta-analysis

Zhang,

Tan,

Gao

et al. 2024

Geriatric Nursing

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A systematic review of frailty assessment tools used in vascular surgery research

Cited by 10 publications

References 178 publications

Prevalence and adverse outcomes of pre-operative frailty in patients undergoing carotid artery revascularization: a meta-analysis

Prevalence and adverse outcomes of pre-operative frailty in patients undergoing carotid artery revascularization: a meta-analysis

Frailty Assessment in Vascular OUtpatients Review (FAVOUR) protocol: single-centre prospective cohort study comparing feasibility and prognostic value of commonly used frailty assessment tools

Prediction of postoperative mortality in older surgical patients by clinical frailty scale: A systematic review and meta-analysis

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