The Impact of Frailty on Outcomes of Elderly Patients After Major Vascular Surgery: A Systematic Review and Meta-analysis

Wang, Jiarong; Zou, Yuan; Zhao, Jichun; Schneider, Darren B.; Yang, Yi; Ma, Ying; Huang, Bin; Yuan, Ding

doi:10.1016/j.ejvs.2018.07.012

Cited by 80 publications

(50 citation statements)

References 48 publications

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“…Frail patients have been found to have increased cardiopulmonary complications after emergency general surgery, increased mortality after major vascular surgery and increased mortality and decreased return to living at home after intensive care . Therefore, it seems likely that frailty would adversely affect recovery after in‐hospital cardiac arrest, but the association of frailty and outcome in this patient population has not previously been examined.…”

Section: Introductionmentioning

confidence: 99%

“…2 Frailty can also be identified from the accumulation of problems, such as low mood, impaired sleep, urinary incontinence, tremor, impaired coordination, poor standing posture, reduced muscle tone, irregular gait, falls, memory impairment and cognitive impairment. 3 Frail patients have been found to have increased cardiopulmonary complications after emergency general surgery, 4 increased mortality after major vascular surgery 5 and increased mortality and decreased return to living at home after intensive care. 6 Therefore, it seems likely that frailty would adversely affect recovery after in-hospital cardiac arrest, but the association of frailty and outcome in this patient population has not previously been examined.…”

Section: Introductionmentioning

confidence: 99%

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Frailty is associated with reduced prospect of discharge home after in‐hospital cardiac arrest

Smith

Reid

Santamaria

2019

Internal Medicine Journal

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Background Frailty is common among acute hospital patients and might adversely affect recovery from inpatient cardiac arrest. Aim To assess the relationship between hospital admission characteristics, including frailty, and discharge outcome after in‐hospital cardiac arrest. Methods Prospectively collected data were retrospectively analysed for all separations from a tertiary hospital during 2008–2017 that involved rapid response team attendance for cardiac arrest. Hospital Frailty Risk Score (HFRS) and Charlson index of comorbidity were calculated from ‘primary’ and ‘associated’ International Classification of Diseases, 10th revision, Australian Modification diagnoses. HFRS ≥5 was taken to signify frailty. Discharge home from hospital and death in hospital were modelled using logistic regression. Results There were 388 in‐hospital arrest patients: 91% were aged ≥50 years, 34% were previously discharged in the past 6 months, 66% were unplanned admissions, 63% were non‐cardiology‐cardiothoracic admissions, 45% had a Charlson comorbidity index ≥2 and 19% were identified as frail. Discharge home occurred in 22%, discharge to another hospital 17% and death 62%. Of the frail patients, only 3 (4%) were discharged home, 12 (17%) were discharged to another hospital and 57 (79%) died in hospital. Fewer frail patients were discharged home compared with non‐frail patients (4 vs 26%; odds ratio (OR) 0.13, P = 0.001). On multivariable analysis, patients were less likely to be discharged home if they had frailty (OR 0.24, P = 0.02), age ≥ 50 years (OR 0.36, P = 0.01), non‐cardiology‐cardiothoracic unit admission (OR 0.40, P = 0.001) and unplanned admission (OR 0.57, P = 0.04). Frail patients discharged to another hospital spent a median of 15 days (interquartile range 11–23) in the hospital post‐arrest before leaving to continue inpatient care elsewhere. Frailty was associated with death in hospital on univariate analysis (79 vs 58%; OR 2.80, P = 0.001) but not after controlling for other factors. Conclusion Frail patients are unlikely to make a good recovery after in‐hospital arrest. This should be taken into account when planning care with patients and their families.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Frailty is associated with reduced prospect of discharge home after in‐hospital cardiac arrest

Smith

Reid

Santamaria

2019

Internal Medicine Journal

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“…(1) There is considerable evidence that frail older patients represent a subgroup at higher risk of adverse postoperative outcomes, including longer hospital lengths of stay and increased mortality. (2,3) In a meta-analysis on general surgery patients, frail patients had a 30-day postoperative mortality of 8%, compared to 1% in the non-frail group. Readmission rates and complications were also higher in the frail group.…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Sarcopenia and Frailty as Predictors of Postoperative Complications: 65 Years and Older Non-Cardiac Surgery Cohort Study

Shema

Forget

Bouchard

et al. 2020

Preprint

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BackgroundSarcopenia and frailty are two different concepts with specific measures. Nonetheless, they share similarities. Whether one is a better predictor of postoperative adverse outcomes in older adults has not been well studied. Our main objective was to evaluate the psoas muscle index (PMI), used as a surrogate for sarcopenia, and the Clinical Frailty Scale (CFS) association with postoperative complications incidence. Our secondary objective was to evaluate the correlation between PMI and CFS in a cohort of non-cardiac surgery patients. MethodsWe conducted a prospective observational cohort study. Patients 65 years and older undergoing elective non-cardiac surgery in a tertiary academic center were included. Right and left psoas areas were measured on a CT scan at the fourth lumbar vertebra body level, and the sum was normalized for squared height (PMI). Sarcopenia was defined as PMI lowest tertile. The National Surgical Quality Improvement Program defined postoperative complications. We performed a negative binomial regression analysis to assess the association with postoperative complications and compared the model fit using the Akaike information criterion (AIC). Correlation between PMI and CFS was analyzed using the Spearman correlation.ResultsA total of 78 patients were included. Median PMI was 6.23 cm2/m2 (interquartile range (IQR): 5.29 – 7.21 cm2/m2) for women and 7.77 cm2/m2 (IQR: 6.49 – 8.55 cm2/m2) for men. In multivariate analysis, lower PMI tertile was significantly associated with an increasing number of complications (incidence rate ratio (IRR): 2.26, confidence interval (CI 95%): 1.01 – 5.56, p = 0.048) while CFS was not. AIC was lower with the PMI model compared to the CFS model. The correlation coefficient between PMI and CSF was -0.241 (p = 0.044).ConclusionsIn our cohort, PMI was a better predictor of postoperative complications than CFS. The correlation between PMI and CFS was weak. An objective measure of sarcopenia, compared to the broader concept of frailty, might be an easier way to identify patients with higher risks of complications. Trial registrationRetrospective ethics approval

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“…Around 10% of people aged over 65 years are frail, increasing to more than 30% of those aged over 85 years, while prevalence of frailty in patients with SLI may be over 50% 11 14 15. Frail patients are less able to respond to acute stressors, such as major surgery, and are therefore more susceptible to adverse health outcomes such as mortality and postoperative complications 16 17. Multiple validated tools used to assess patients for frailty have been developed which can be used in preoperative assessment 13 18…”

Section: Introductionmentioning

confidence: 99%

“…Sarcopenia has been assessed both clinically and radiologically (using cross-sectional imaging) in vascular patients 23 24. Frailty, cognitive impairment and sarcopenia have been implicated in worse outcome following vascular surgery 17. Postoperative delirium is one such outcome which has been shown to be associated both with frailty in vascular patients and worse short-term and long-term outcome following vascular surgery 25 26…”

Section: Introductionmentioning

confidence: 99%

Leg ischaemia management collaboration (LIMb): study protocol for a prospective cohort study at a single UK centre

et al. 2019

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IntroductionSevere limb ischaemia (SLI) is the end stage of peripheral arterial occlusive disease where the viability of the limb is threatened. Around 25% of patients with SLI will ultimately require a major lower limb amputation, which has a substantial adverse impact on quality of life. A newly established rapid-access vascular limb salvage clinic and modern revascularisation techniques may reduce amputation rate. The aim of this study was to investigate the 12-month amputation rate in a contemporary cohort of patients and compare this to a historical cohort. Secondary aims are to investigate the use of frailty and cognitive assessments, and cardiac MRI in risk-stratifying patients with SLI undergoing intervention and establish a biobank for future biomarker analyses.Methods and analysisThis single-centre prospective cohort study will recruit patients aged 18–110 years presenting with SLI. Those undergoing intervention will be eligible to undergo additional venepuncture (for biomarker analysis) and/or cardiac MRI. Those aged ≥65 years and undergoing intervention will also be eligible to undergo additional frailty and cognitive assessments. Follow-up will be at 12 and 24 months and subsequently via data linkage with NHS Digital to 10 years postrecruitment. Those undergoing cardiac MRI and/or frailty assessments will receive additional follow-up during the first 12 months to investigate for perioperative myocardial infarction and frailty-related outcomes, respectively. A sample size of 420 patients will be required to detect a 10% reduction in amputation rate in comparison to a similar sized historical cohort, with 90% power and 5% type I error rate. Statistical analysis of this comparison will be by adjusted and unadjusted logistic regression analyses.Ethics and disseminationEthical approval for this study has been granted by the UK National Research Ethics Service (19/LO/0132). Results will be disseminated to participants via scientific meetings, peer-reviewed medical journals and social media.Trial registration numberNCT04027244.

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The Impact of Frailty on Outcomes of Elderly Patients After Major Vascular Surgery: A Systematic Review and Meta-analysis

Cited by 80 publications

References 48 publications

Frailty is associated with reduced prospect of discharge home after in‐hospital cardiac arrest

Frailty is associated with reduced prospect of discharge home after in‐hospital cardiac arrest

Comparison Between Sarcopenia and Frailty as Predictors of Postoperative Complications: 65 Years and Older Non-Cardiac Surgery Cohort Study

Leg ischaemia management collaboration (LIMb): study protocol for a prospective cohort study at a single UK centre

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