Frailty Index (mFI-5) Predicts Resource Utilization after Nonruptured Endovascular Aneurysm Repair

Balasundaram, Naveen; Chandra, Isaiah; Sunilkumar, Vishruth Thaghalli; Kanake, Shubham; Bath, Jonathan; Vogel, Todd R.

doi:10.1016/j.jss.2022.10.045

Cited by 7 publications

(5 citation statements)

References 15 publications

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“…Our data suggest that the etiology and bacteriology of perianal abscesses in elderly patients differ from the disease in younger patients. However, as is known from other surgical interventions [ 17 , 18 , 19 , 20 , 21 , 22 ], our data also reveal that the frailty status of aged people—and not their chronological age—mainly determines the outcome in both the short as well as longer term after surgery for perianal abscesses. These findings are the expression of the multidimensional frailty syndrome, which involves physiological and psychological aspects and results in loss of functional reserve and increased vulnerability upon surgery, as stated recently by Cappe et al [ 18 ].…”

Section: Discussionsupporting

confidence: 76%

“…It is known from other formally trivial diseases in general surgery, that elderly patients are at higher risk for experiencing a more severe and complicated course [ 17 ]. However, it is less the chronologic age than the multidimensional frailty syndrome, which dramatically increases the risk for poor outcome and consecutively for additional resource utilization after various elective and urgent surgical interventions [ 17 , 18 , 19 , 20 , 21 , 22 ]. This is currently unknown for patients with perianal abscesses, thus further research is needed to investigate this relevant issue in more detail.…”

Section: Introductionmentioning

confidence: 99%

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New Perianal Sepsis Risk Score Predicts Outcome of Elderly Patients with Perianal Abscesses

Reichert

Eckerth

Fritzenwanker

et al. 2023

JCM

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Antibiotic therapy following surgical perianal abscess drainage is debated, but may be necessary for high-risk patients. Frailty has been shown to increase the risk of unfavorable outcomes in elderly surgical patients. This study aims to identify high-risk patients by retrospectively analyzing a single-center cohort and using a pretherapeutic score to predict the need for postoperative antibiotics and extended nursing care following perianal abscess drainage surgery. The perianal sepsis risk score was developed through univariable and multivariable analysis. Internal validation was assessed using the area under receiver-operating characteristic curve. Elderly, especially frail patients exhibited more severe perianal disease, higher frequency of antibiotic therapy, longer hospitalization, poorer clinical outcomes. Multivariable analysis revealed that scores in the 5-item modified frailty index, severity of local infection, and preoperative laboratory markers of infection independently predicted the need for prolonged hospitalization and anti-infective therapy after abscess drainage surgery. These factors were combined into the perianal sepsis risk score, which demonstrated better predictive accuracy for prolonged hospitalization and antibiotic therapy compared with chronological age or frailty status alone. Geriatric assessments are becoming increasingly important in clinical practice. The perianal sepsis risk score identifies high-risk patients before surgery, enabling early initiation of antibiotic therapy and allocation of additional nursing resources.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

New Perianal Sepsis Risk Score Predicts Outcome of Elderly Patients with Perianal Abscesses

Reichert

Eckerth

Fritzenwanker

et al. 2023

JCM

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“…In addition to 30-day mortality, frailty was also found to predict hospital stay > 30 days (p = 0.02), readmission (p < 0.001), and prolonged intensive care unit stay > 3 days (p < 0.001). In one study [16], the readmission rate went from 5% in non-frail patients to 12.3% in patients with mFI-5 (0.6-1.0). Harris et al [15] found 4% of systemic complications in non-frail patients vs. 13% in frail patients (p < 0.001), and Tse et al [14] found 8% of systemic complications in non-frail patients vs. 13% in frail patients (p < 0.001).…”

Section: Frailty and 30-day Mortalitymentioning

confidence: 98%

“…The mFI-5 score for each patient was determined by dividing the number of criteria present by the total number of variables assessed (n/5). As previously reported, a score of 0.6 or greater on the mFI-5 was indicative of frailty [16]. Studies using other methods for measuring frailty, such as the Risk Analysis Index (RAI) [14] and other measures of preoperative functional status, were converted to mFI-5 scores.…”

Section: Five-factor Modified Frailty Index (Mfi-5)mentioning

confidence: 99%

“…Frailty (mFI-5 ≥ 0.6) was associated with a significantly increased 30-day mortality in patients who underwent elective EVAR (Figure 2) according to the fixed effects method (OR, 4.93, 95% CI 3.73-6.52, p < 0.001) and the random effects method (OR, 4.84, 95% CI 3.34-7.00, p < 0.001) [13][14][15][16]. The heterogeneity of the studies was moderate (I 2 : 42.9%, p = 0.15).…”

Section: Frailty and 30-day Mortalitymentioning

confidence: 99%

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Impact of Frailty and Sarcopenia on Thirty-Day and Long-Term Mortality in Patients Undergoing Elective Endovascular Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis

Saucy,

Probst,

Hungerbühler

et al. 2024

JCM

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Background: The aim of this study was to assess the prognostic role of frailty and sarcopenia on the survival of patients with AAA undergoing elective endovascular repair (EVAR). Methods: A systematic review of the literature was conducted in accordance with Meta-analysis of Observational Studies in Epidemiology (MOOSE). The association of frailty or sarcopenia with 30-day mortality and late survival was expressed as odds ratios (ORs) or hazard ratios (HRs) with a 95% confidence interval (CI). Meta-analysis random effects models were applied. The five-factor modified frailty index (mFI-5) was used as a frailty metric and sarcopenia was determined using computed tomography angiography (CTA) with measurements of the total psoas muscle area. Frailty was defined as patients with mFI-5 ≥ 0.6 and sarcopenia was defined as the total psoas muscle area (TPA) within the lowest tertile. Results: Thirteen observational cohorts reporting a total of 56,756 patient records were eligible for analysis. Patients with frailty (mFI-5 ≥ 0.6) had significantly increased 30-day mortality than those without frailty (random effects method: OR, 4.84, 95% CI 3.34–7.00, p < 0.001). Patients with sarcopenia (lowest TPA tertile) had significantly increased 30-day mortality according to the fixed effects method (OR, 3.30, 95% CI 2.17–5.02, p < 0.001), but not the random effects method (OR, 2.64, 95% CI 0.83–8.39, p = 0.098). Patients with sarcopenia or frailty had a significantly increased hazard ratio (HR) for late mortality than those without frailty or sarcopenia according to the random effects method (HR, 2.39, 95% CI 1.66–3.43, p < 0.001). The heterogeneity of the studies was low (I2: 0.00%, p = 0.86). The relation of frailty to age extracted from four studies demonstrates that the risk of frailty increases with age according to the random effects method (standard mean differences, SMD, 0.52, 95% CI 0.44–0.61, p < 0.001). The heterogeneity of the studies was low (I2: 0.00%, p = 0.64). Conclusions: Patients with sarcopenia or frailty have a significantly increased risk of mortality following elective EVAR. Prospective studies validating the use of frailty and sarcopenia for risk prediction after EVAR are needed before these tools can be used to support decision making.

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Association Between Modified Frailty Index and Postoperative Outcomes of Cricopharyngeal Myotomy

Haleem,

Herz,

Kumar

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveThe modified 5‐item frailty index (mFI‐5) is a comorbidity‐based risk stratification tool previously validated in patients undergoing several surgical procedures. This study investigates the association between mFI‐5 score and cricopharyngeal myotomy (CM) complications.Study DesignRetrospective database review.SettingUS hospitals.MethodsThe National Surgical Quality Improvement Program database was queried for patients who underwent CM between 2005 and 2018. mFI‐5 score was determined by assigning 1 point for comorbidities including: diabetes mellitus, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and dependent health status. Univariate and multivariable analyses were conducted to determine associations between mFI‐5 score and postoperative complications.ResultsA total of 1075 patients undergoing CMs were queried and stratified into the following groups: mFI = 0 (n = 412 [38.3%]), mFI = 1 (n = 452 [42.0%]), and mFI ≥ 2 (n = 211 [19.6%]). Univariate analysis showed association between higher mFI‐5 scores with older age, higher American Society of Anesthesiologists Classification class, obesity, smoking, dyspnea, and systemic sepsis. Higher mFI‐5 was associated with a greater proportion of cumulative surgical complications, cumulative medical complications, pneumonia, myocardial infarction, cumulative morbidity, readmissions, unplanned readmissions, and reoperations. Multivariable analyses found associations between greater mFI‐5 score and cumulative morbidity (odds ratio [OR] = 1.95, confidence interval [CI]: 1.29‐2.96, P = .002), any surgical complication (OR = 1.80, CI: 1.15‐2.79, P = .010), readmission (OR = 1.81, CI: 1.01‐3.26, P = .047), and reoperations (OR = 1.96, CI: 1.04‐3.68, P = .037).ConclusionEvaluating mFI‐5 can help assess the risk of postoperative complications for patients undergoing CM.Level of EvidenceLevel 4.

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Frailty Index (mFI-5) Predicts Resource Utilization after Nonruptured Endovascular Aneurysm Repair

Cited by 7 publications

References 15 publications

New Perianal Sepsis Risk Score Predicts Outcome of Elderly Patients with Perianal Abscesses

New Perianal Sepsis Risk Score Predicts Outcome of Elderly Patients with Perianal Abscesses

Impact of Frailty and Sarcopenia on Thirty-Day and Long-Term Mortality in Patients Undergoing Elective Endovascular Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis

Association Between Modified Frailty Index and Postoperative Outcomes of Cricopharyngeal Myotomy

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