<p>Frailty In Patients Undergoing Vascular Surgery: A Narrative Review Of Current Evidence</p>

Abstract

Frailty is presumably associated with an elevated risk of postoperative mortality and adverse outcome in vascular surgery patients. The aim of our review was to identify possible methods for risk assessment and prehabilitation in order to improve recovery and postoperative outcome. The literature search was performed via PubMed, Embase, OvidSP, and the Cochrane Library. We collected papers published in peer-reviewed journals between 2001 and 2018. The selection criterion was the relationship between vascular surgery, frailty and postoperative outcome or mortality. A total number of 52 publications were included. Frailty increases the risk of non-home discharge independently of presence or absence of postoperative complications and it is related to a higher 30-day mortality and major morbidity. The modified Frailty Index showed significant association with elevated risk for post-interventional stroke, myocardial infarction, prolonged in-hospital stays and higher readmission rates. When adjusted for comorbidity and surgery type, frailty seems to impact medium-term survival (within 2 years). Preoperative physical exercising, avoidance of hypalbuminemia, psychological and cognitive training, maintenance of muscle strength, adequate perioperative nutrition, and management of smoking behaviours are leading to a reduced length of stay and a decreased incidence of readmission rate, thus improving the effectiveness of early rehabilitation. Pre-frailty is a dynamically changing state of the patient, capable of deteriorating or improving over time. With goal-directed preoperative interventions, the decline can be prevented.

Preoperative nutritional state is associated with mid- and long-term mortality after cardiac surgery

“…Clinical experience suggests that there should be other factors influencing postoperative outcome in addition to routine physiological risk stratifications. These are likely to be social, functional and psychological (3,4). Over the past two decades, researchers have begun to address frailty, which is used to describe a multidimensional syndrome of reserve deficiency (cognitive function, health status, physical ability), although it has not been easy to standardize.…”

Study protocol for COvid-19 Vascular sERvice (COVER) study: The impact of the COVID-19 pandemic on the provision, practice and outcomes of vascular surgery

“…Vascular patients are, for the majority, considered high risk for respiratory compromise and subsequent mortality if they contract COVID-19 [ 3 , 4 ]. They are often frail, elderly, comorbid, and have less respiratory and physiological reserve than many others who contract the SARS-CoV2 virus [ 5 ]. A significant proportion of vascular surgical practice involves performing prophylactic operations to reduce the risk of a future cardiovascular event, for example carotid endarterectomy to prevent stroke or abdominal aortic aneurysm repair to prevent rupture.…”

Effects of frailty on postoperative clinical outcomes of aneurysmal subarachnoid hemorrhage: results from the National Inpatient Sample database

“…It is found in 2 out of every 10 adults aged 65 years and older and associated with adverse outcomes such as limited physical activity, falls, emergency department visits, greater likelihood of institutional care, and poor quality of life among community-dwelling older peoples [ 5 ]. Frailty is considered a valid predictor of adverse postoperative clinical outcomes and linked with perioperative morbidity and mortality in various surgical settings, including emergent or non-emergent general surgery [ 6 ], major and minimally invasive cardiac surgery [ 7 , 8 ], cranial neurosurgery [ 9 , 10 ], and transsphenoidal pituitary surgery [ 11 ]. Frailty is also noted for risk prediction in critically ill patients with various diagnoses, including stroke and intensive care patients requiring organ support [ 12 , 13 ].…”