Frailty and Sarcopenia in Vascular Surgery Patients: A Systematic Review and Meta-analysis of Patient Factors and Outcomes

Houghton, John S M; Nickinson, Andrew; Morton, Alastair; Nduwayo, Sarah; Rayt, Harjeet; Gray, Laura J.; Haunton, Victoria J.; Sayers, Rob

doi:10.1016/j.ejvs.2019.09.260

Cited by 22 publications

(33 citation statements)

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“…Frailty was an independent predictor of delirium but not functional decline after adjusting for other variables including admission status and surgical management approach. Taken together with previous studies, 5,17,35,36 these findings clearly implicate an association between frailty and delirium, one of the most serious complications in hospitalized older vascular surgery patients 43 . Both the FI and CFS demonstrated acceptable prognostic discrimination for delirium, but poor discrimination for functional decline, similar to the few prior studies in surgical patients 15‐17 .…”

Section: Discussionsupporting

confidence: 81%

“…Several studies in vascular surgery cohorts demonstrated an association between preoperative frailty and increased mortality and complications 5 but only a few examined the impact of frailty on hospital‐acquired geriatric syndromes 5,17,35,36 . In our study, frail patients had significantly more incident delirium, functional decline, and high‐risk prescribing when compared to fit patients.…”

Section: Discussionmentioning

confidence: 60%

“…Frail patients as per the FI had a significantly greater hospital LOS. These findings about outcomes in frail hospitalized vascular surgery patients build on the literature which to date has been limited largely to retrospective or cross‐sectional studies that have not used a validated frailty measure and have been undertaken in elective or single procedure/condition specific cohorts only (e.g., abdominal aortic aneurysm repair or revascularization for lower‐extremity arterial disease) 5 …”

Section: Discussionmentioning

confidence: 90%

“…Frailty is associated with worse outcomes in vascular surgery patients. A recent systematic review and meta‐analysis of 62,976 vascular surgery patients across 18 studies found that frailty was associated with significantly increased postoperative complications, 30‐day mortality, and long‐term mortality 5 . Only a few studies investigated the association between frailty and hospital acquired geriatric syndromes 5 .…”

Section: Introductionmentioning

confidence: 99%

“…A recent systematic review and meta‐analysis of 62,976 vascular surgery patients across 18 studies found that frailty was associated with significantly increased postoperative complications, 30‐day mortality, and long‐term mortality 5 . Only a few studies investigated the association between frailty and hospital acquired geriatric syndromes 5 . The American College of Surgeons (ACS) has identified geriatric syndromes, in particular postoperative delirium and functional decline, as important outcomes that should be measured, especially in the frail older surgical population 6 .…”

Section: Introductionmentioning

confidence: 99%

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The Prognostic Performance of Frailty for Delirium and Functional Decline in Vascular Surgery Patients

Thillainadesan

Mudge

Aitken

et al. 2020

J American Geriatrics Society

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Background Frailty in older vascular surgery patients is associated with increased mortality, hospital stay, and morbidity. The association of frailty with hospital‐acquired geriatric syndromes such as delirium and functional decline has not been well studied. Objectives To investigate the association between frailty and hospital‐acquired geriatric syndromes in older hospitalized vascular surgery patients, and to evaluate the prognostic performance of the frailty index (FI) and the Clinical Frailty Scale (CFS) for delirium and functional decline. Design Prospective cohort study. Setting Acute care academic hospital. Participants Patients aged 65 years or more admitted to a tertiary vascular surgery unit (N=150). Measurements Frailty was assessed using the FI and CFS. The adjusted association of frailty status with delirium and functional decline was assessed using logistic regression analysis. The prognostic performance of FI and CFS was determined by assessing C‐statistic and positive and negative predictive values (PPV and NPV). Results Of 150 participants, FI identified 34 (23%) and CFS identified 45 (30%) as frail. Frailty was an independent predictor of delirium (FI adjusted odds ratio, odds ratio (OR) = 5.66, 95% confidence interval (CI) = 1.53–21.03; CFS adjusted OR = 4.07, 95% CI = 1.14–14.50), but not functional decline. FI and CFS showed acceptable prognostic performance for delirium (C‐statistic 0.74), but not functional decline (C‐statistic 0.63–0.64). For both outcomes, the FI and CFS had high NPV (86–96%), and low PPV (22–29%). Conclusion Frail older vascular surgery patients are more likely to develop hospital‐acquired geriatric syndromes. The FI and CFS have acceptable prognostic performance for predicting delirium but not all individuals who are identified as frail develop delirium. Ongoing research is needed to identify interventions that improve outcomes in patients who screen positive for frailty.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The Prognostic Performance of Frailty for Delirium and Functional Decline in Vascular Surgery Patients

Thillainadesan

Mudge

Aitken

et al. 2020

J American Geriatrics Society

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Impairment of Activities of Daily Living is an Independent Risk Factor for Recurrence and Mortality Following Curative Resection of Stage I–III Colorectal Cancer

Mima

Kosumi

Miyanari

et al. 2021

Journal of Gastrointestinal Surgery

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The Impact of Frailty on COVID-19 Outcomes: A Systematic Review and Meta-analysis of 16 Cohort Studies

Yang

Luo

Jiang

et al. 2021

The Journal of nutrition, health and aging

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Background: Frail patients are increasingly vulnerable to stress, which is mainly manifested by a reduced physiologic reserve in metabolic and immune systems and neuromuscular system. Several studies found a significant association of frailty with COVID-19 severity to support the evidence for the application of frailty assessment. However, there were contradictory results in other studies. Thus we conducted a systematic review and meta-analysis to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice. Objective: We aimed to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice. Design: A systematic review and Meta-analysis of 16 cohort studies. Participants: Patients with COVID-19. Methods: A systematic retrieving for potential literature was conducted in several public electronic databases, including Medline(OvidSP), EMBASE, Pubmed and Chinese databases(China National Knowledge Infrastructure,Wanfang and Weipu) on August 1, 2020.The literature research was updated on October 26, 2020. Newcastle Ottawa Scale for cohort studies was used for quality assessment. RevMan (Version 5.3) and Stata 14.0 were used to synthesize the pooled effects. Results: According to the predefined inclusion and exclusion criteria, sixteen studies of 4324 patients were included in the final analysis. Frailty was significantly associated with increased risk of all-cause mortality among patients with COVID-19, with pooled adjusted odds ratios of 1.81 (95% confidence intervals:1.48,2.21, I2=87.0%, P<0.001). The result was consistent in stratified analysis to according to age, patient source, definitions of frailty, study quality, and adjustment method. Frailty was significant associated with an increased risk of COVID-19 severity, admission to intensive care unit, application of invasive mechanical ventilation, long-length stay. Conclusions: In this meta-analysis, we found frailty was significantly associated with an increased risk of clinical adverse events (all-cause mortality, COVID-19 severity, admission to the intensive care unit, application of invasive mechanical ventilation, long-length stay). Given the epidemic of COVID-19 and shortage of medical resources, paying more attention to screening frailty would contribute to disease management and resource allocation among patients with COVID-19.

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Frailty and Sarcopenia in Vascular Surgery Patients: A Systematic Review and Meta-analysis of Patient Factors and Outcomes

Cited by 22 publications

References 0 publications

The Prognostic Performance of Frailty for Delirium and Functional Decline in Vascular Surgery Patients

The Prognostic Performance of Frailty for Delirium and Functional Decline in Vascular Surgery Patients

Impairment of Activities of Daily Living is an Independent Risk Factor for Recurrence and Mortality Following Curative Resection of Stage I–III Colorectal Cancer

The Impact of Frailty on COVID-19 Outcomes: A Systematic Review and Meta-analysis of 16 Cohort Studies

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