Association Between Preoperative Frailty and Mortality in Patients With Critical Limb Ischemia Following Infrainguinal Bypass Surgery　― Usefulness of the Barthel Index ―

Abstract

Background: Most patients with critical limb ischemia (CLI) exhibit severe comorbidities accompanied by frailty. This study assessed and risk-stratified mortality after infrainguinal bypass (IB) in CLI and investigated the effects of frailty. Methods and Results:The study retrospectively reviewed 107 consecutive CLI patients who had undergone de novo IB due to atherosclerotic disease. Data regarding patient age, comorbidities, laboratory data, and functional status were collected; functional status was evaluated using the Barthel index (BI) and nutritional status was evaluated using albumin concentrations and body mass index (BMI). Mean (±SD) BI and BMI were 75±16 and 22±4 kg/m 2 , respectively. BI (hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.94-0.99, P=0.004), BMI (HR 0.85; 95% CI 0.75-0.95, P=0.003), atrial fibrillation (AF; HR 5.31; 95% CI 2.12-13.30, P<0.001), and ejection fraction (EF; HR 0.94; 95% CI 0.91-0.98, P=0.003) were independent predictors of mortality. Patients were divided into 2 groups based on BI (BI >75, n=71; and BI <70, n=36). Survival after IB was significantly lower for the lower BI group (P<0.001, log-rank test). After propensity score matching, post-IB survival remained significantly lower in the lower BI group (P=0.02).Conclusions: BI, BMI, AF, and EF were independently associated with all-cause mortality after IB for CLI. BI and BMI may be useful in identifying and optimizing treatment for high-risk frail patients.

The Impact of Frailty on Outcomes of Elderly Patients After Major Vascular Surgery: A Systematic Review and Meta-analysis

“…1). Seven multi-domain tools were adopted in 12 studies to assess frailty status before vascular procedures: the Groningen Frailty Indicator (GFI), 8 Edmonton Frail Scale (EFS), 31 modified Frailty Index (mFI), 13,14,26,29,30 Barthel Index (BI), 15 Addenbrooke's Vascular Frailty Score (AVFS), 28 Ruptured Aneurysm Frailty Score (RAFS), 27…”

“…35 Six studies were conducted in patients who underwent major vascular surgery, 7,8,28,30,31,34 nine studies in patients with AAA, 11,12,14,27,33,36e39 and 10 studies in patients with LEAD. 10,13,15,25,26,29,32,33,35,40 The basic characteristics of the included studies are given in Table 1.…”

<p>Main Risk Factors Related to Activities of Daily Living in Non-Dialysis Patients with Chronic Kidney Disease Stage 3–5: A Case–Control Study</p>

“…29 A study of patients with severe limb ischemia also compared patients with high BI and low BI to determine whether BI is useful for risk stratification after bypass surgery. 30 It is well known that the dependence of the elderly on the abilities of daily living increases with age. A study on the factors influencing the daily life of elderly people in China found that older age was a relevant factor for the loss of activities of daily living.…”

Outcomes of hospital admissions among frail older people: a 2-year cohort study

“…[24][25][26] This study adds to a growing body of evidence relating to the value of frailty as a predictor of mortality risk across a range of populations and settings. 23,[27][28][29][30][31][32] Implications for research and practice There are compelling reasons to avoid unnecessary hospitalisation in older people, including the risks of deconditioning and iatrogenic harm. 8 However, the data presented in this study demonstrate poor outcomes even among frail older people discharged from hospital after brief (<72 hours) stays, suggesting that early discharge is not (on its own) sufficient to meet the needs of these patients.…”