Effect of frailty syndrome on the outcomes of patients with carotid stenosis

Pandit, Viraj; Lee, Ashton; Zeeshan, Muhammad; Goshima, Kaoru R.; Tan, Tze‐Woei; Jhajj, Sandeep; Trinidad, Bradley; Weinkauf, Craig; Wei, Zhou

doi:10.1016/j.jvs.2019.08.235

Cited by 33 publications

(30 citation statements)

References 19 publications

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“…After applying the in-and exclusion criteria, 2,686 articles were excluded. Out of the remaining 41 full-texts, 27 studies were excluded because of using a single-domain frailty tool, and six for miscellaneous reasons (i.e., full-text not accessible or no primary data presented), resulting in eight articles that were included in this systematic review (20)(21)(22)(23)(24)(25)(26)(27).…”

Section: Resultsmentioning

confidence: 99%

“…After quality assessment, six studies were identified as having low risk of bias (22)(23)(24)(25)(26)(27) and two studies as having moderate risk of bias (20,21) (Table 1). All studies focused on pre-operative frailty status (Table 2).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Seven were retrospective cohort studies (20,(22)(23)(24)(25)(26)(27) and one was a prospective cohort study (21). All studies were performed in the USA and six studies (20,(22)(23)(24)(25)27) used the same national database from the National Surgical Quality Improvement Project (NSQIP) to retrieve their data. The three different frailty tools used by the included studies are presented in Table 3 and consist of the Clinical Frailty Scale (CFS) to prospectively collect patient-reported data, and the Risk Analysis Index (RAI) and Modified Frailty Index (MFI) to retrospectively collect data, retrieved from medical records.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Seven out of eight studies (20,(22)(23)(24)(25)(26)(27) included the preoperative prevalence of frail and non-frail CEA patients and were therefore included in the pooled prevalence analysis (Figure 2). The pooled prevalence for pre-operative frailty was 22.07% (95% CI: 16.35-27.79), with a high level of heterogeneity (I 2 =100%, P<0.01).…”

Section: Prevalence Of Pre-operative Frailtymentioning

confidence: 99%

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Role of pre-operative frailty status in relation to outcome after carotid endarterectomy: a systematic review

Benjamens¹,

Bokkers²,

Zeebregts³

et al. 2021

Ann Transl Med

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Carotid endarterectomy (CEA) is a surgical treatment option to prevent ischemic cerebrovascular accidents. Patients that present with pre-operative frailty might have an elevated risk for unfavorable outcomes after the CEA. A systematic search, using Medline, Embase, Web of Science and Cochrane Database, was performed for relevant literature on frailty in patients undergoing CEA. The study protocol was registered with PROSPERO (CRD42020190345). Eight articles were included. The pooled prevalence for pre-operative frailty was 23.9% (95% CI: 12.98-34.82). A difference in the incidence of complications between frail and non-frail patients (6.4% vs. 5.2%, respectively) and a difference in hospital length of stay [2 (IQR: 2-3) days vs. 1 (IQR: 1-2) day, respectively] were described. The 30-day mortality after CEA was 0.6% for non-frail patients, 2.6% for frail patients, and 4.9% for very frail patients (P<0.001). For 3-year mortality, a >1.5-fold increased risk was found for frail patients (OR 1.7, 95% CI: 1.4-2.0) and a >2.5-fold increased risk for very frail patients (OR 2.6, 95% CI: 2.2-3.1). In conclusion, this review shows the impact of frailty on outcome after CEA. Pre-operative frailty assessment with a validated, multi-domain tool should be implemented in the clinical setting as it will provide information on post-operative surgical outcomes and mortality risk but also frailty trajectory and cognitive decline.

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Prevalence Of Pre-operative Frailtymentioning

confidence: 99%

See 2 more Smart Citations

Role of pre-operative frailty status in relation to outcome after carotid endarterectomy: a systematic review

Benjamens¹,

Bokkers²,

Zeebregts³

et al. 2021

Ann Transl Med

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“…30 In another more recent (2005 to 2012) analysis of the NSQIP data, frailty was strongly associated with morbidity and mortality among patients undergoing CEA, but not CAS. 31 Among 37,875 patients undergoing a carotid intervention, frailty was an independent predictor of complications (23.5% vs. 7.2%, respectively; P<0.001), mortality (5.2% vs. 1.1%, respectively; P=0.02), failure to rescue (12.1% vs. 4.7%, respectively; P=0.02), and 30-day readmissions (14.9% vs. 3.7%, respectively; P=0.03) compared with non-frail patients. Consequently, the potential benefits of offering an intervention (CEA/CAS) plus BMT versus BMT alone in elderly ACS patients must be counterbalanced against the potential risks associated with each option.…”

Section: Patient Age/comorbiditiesmentioning

confidence: 99%

Management of Patients with Asymptomatic Carotid Stenosis May Need to Be Individualized: A Multidisciplinary Call for Action

Paraskevas¹,

Mikhailidis

Baradaran

et al. 2021

J Stroke

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The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g., silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are <3% and the patient’s life expectancy is >5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized.

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Carotid revascularization and cognitive impairment: the neglected role of cerebral small vessel disease

et al. 2021

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Effect of frailty syndrome on the outcomes of patients with carotid stenosis

Cited by 33 publications

References 19 publications

Role of pre-operative frailty status in relation to outcome after carotid endarterectomy: a systematic review

Role of pre-operative frailty status in relation to outcome after carotid endarterectomy: a systematic review

Management of Patients with Asymptomatic Carotid Stenosis May Need to Be Individualized: A Multidisciplinary Call for Action

Carotid revascularization and cognitive impairment: the neglected role of cerebral small vessel disease

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