Current Clinical Implications of Frailty and Sarcopenia in Vascular Surgery: A Comprehensive Review of the Literature and Consideration of Perioperative Management

Abstract

Frailty is a well-known geriatric syndrome of impaired physiological reserve and increased vulnerability to stressors. Sarcopenia is also used as a parameter of physical impairment characterized by muscle weakness. As population aging has become more prominent in recent years, both modalities are now regarded as clinically important prognostic tools defined by multidimensional factors that may affect clinical outcomes in various clinical settings. A preoperative surgical risk analysis is mandatory to predict clinical and surgical outcomes in all surgical practices, particularly in high-risk surgical patients. In vascular surgical settings, frailty and sarcopenia have been accepted as useful prognostic tools to evaluate patient characteristics before surgery, as these may predict perioperative clinical and surgical outcomes. Although minimally invasive surgical approaches, such as endovascular therapy, and hybrid approaches have been universally developed, achieving good vascular surgical outcomes for high-risk cohorts remains to be challenge due to the increasing prevalence of elderly patients and multiple preoperative co-morbidities in addition to frailty and sarcopenia. Therefore, to further improve clinical and surgical outcomes, these preoperative geriatric prognostic factors will be of great importance and interest in vascular surgical settings for both physicians and surgeons.

Cardiovascular risk management in the peri‐operative setting

“…Frailty, characterised by an increased vulnerability to adverse health outcomes and commonly associated with ageing, is now increasingly recognised as a significant factor in peri‐operative risk assessment. Adjusting risk evaluation based on frailty assessment using a validated screening tool among patients aged 70 years or older in addition to functional capability measures, such as self‐reported ability to climb two flights of stairs, carries an ESC/ESA class IIa, level B recommendation 8,28,29 …”

Validity of computed tomography defined body composition as a prognostic factor for functional outcome after kidney transplantation

“…Sarcopenia has been defined by the European Working Group on Sarcopenia in Older People as a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes 4 . Studies conducted in various other surgical populations have demonstrated that sarcopenia is associated with greater rates of postoperative complications, intensive care unit admittance, increased duration of hospital stay and overall increased economic burden 5–9 . Therefore, illustrating the importance of quantifying a patient's muscle mass and diagnosing sarcopenia preoperatively.…”

“… 4 Studies conducted in various other surgical populations have demonstrated that sarcopenia is associated with greater rates of postoperative complications, intensive care unit admittance, increased duration of hospital stay and overall increased economic burden. 5 , 6 , 7 , 8 , 9 Therefore, illustrating the importance of quantifying a patient's muscle mass and diagnosing sarcopenia preoperatively. Recent studies have shown that computed tomography (CT) scan analysis is a valid and reliable tool for determining the presence and severity of sarcopenia.…”

A Novel Frailty Score Based on Laboratory Parameters (FIMS Score) for the Management of Older Patients with Severe Aortic Stenosis

“…In the last consensus published by the European Working Group on Sarcopenia in Older People (EWGSOP), it was recommended to measure muscle strength by handgrip using dynamometry and muscle mass mainly by dual-energy X-ray absorptiometry or bioimpedance analysis [ 3 ]. However, this condition is still overlooked in clinical practice, and despite a common effort toward the identification of parameters able to predict clinical and surgical outcomes [ 4 ], a simple and valid method to identify sarcopenia in clinical settings is needed. In particular, the assessment of frailty and sarcopenia may be a useful prognostic tool to predict perioperative clinical and surgical outcomes and may be an important part of the preoperative decision-making process for surgical strategies.…”