Validation of a modified Frailty Index to predict mortality in vascular surgery patients

Ehlert, Bryan A.; Najafian, Alireza; Orion, Kristine C.; Malas, Mahmoud B.; Black, James H.; Abularrage, Christopher J.

doi:10.1016/j.jvs.2015.12.023

Cited by 113 publications

(90 citation statements)

References 29 publications

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“…Ehlert et al 11 compared the mFI to Lee Cardiac Risk Index and the American Society of Anesthesiologists Physical Status Classification to predict 30-day mortality in patients undergoing open carotid revascularization, abdominal aortic aneurysm repair, or lower extremity revascularization using the NSQIP database and found that the frailty score was the best discriminator of mortality. Kraiss et al have developed and validated a frailty model in the Vascular Quality Initiative data using 7 data elements and procedure-based risk estimates to predict 9-month mortality after arterial reconstruction with an AUC of 0.76.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 This biologic syndrome, which results in decreased resistance to stressors and increased vulnerability to morbidity, has been termed frailty. 12 Multiple frailty indices have been developed to scale a patient's AD and predict their operative risk.…”

Section: Introductionmentioning

confidence: 99%

“…13 These scores have consistently been confirmed as independent risk factors for predicting adverse outcomes for surgical patients across a range of specialties including vascular surgery. 10,11,[14][15][16] Both the modified frailty index (mFI), an 11-point index developed in the American College of Surgeon National Surgical Quality Improvement Program (NSQIP) database, and the Risk Analysis Index (RAI), a simplified version of the Porock 6-month mortality index, have been validated in CEA patients in these national data sets demonstrating that an increasing number of AD is associated with increased 30-day adverse events after CEA including stroke, mortality, and length of stay. 11,17,18 The major limitation of the existing analyses using the mFI and RAI is the use of national data sets which specifically lack long-term follow-up data.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

An Accumulated Deficits Model Predicts Perioperative and Long-Term Adverse Events After Carotid Endarterectomy

Sridharan

Chaer

et al. 2017

Annals of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

An Accumulated Deficits Model Predicts Perioperative and Long-Term Adverse Events After Carotid Endarterectomy

Sridharan

Chaer

et al. 2017

Annals of Vascular Surgery

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“…Another study assessing the efect of frailty on outcomes after vascular surgery showed that frailty, assessed by the modiied Frailty Index (mFI), predicted mortality in patients undergoing open procedures and Clavien-Dindo class IV (life-threatening) complications for both open and endovascular abdominal aortic aneurysm repairs [85]. Afecting disposition and, hence, patient wellness and health-care expenditure, frailty also increases the propensity of home-dwelling patients classiied as frail to be discharged to a facility other than their home after elective vascular interventions [86].…”

Section: Frailty and Peripheral Arterial Disease (Pad)mentioning

confidence: 99%

Frailty and Cardiovascular Disease

Chainani¹,

Riehl²,

Chainani³

et al. 2017

Frailty and Sarcopenia - Onset, Development and Clinical Challenges

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Cardiovascular disease (CVD) comprises a vast spectrum of disease states ranging from hypertension (HTN) to valvular heart disease (VHD). CVD is known to be the leading cause of morbidity, mortality, and health-care expenditure throughout the world. According to the World Health Organization, coronary artery disease (CAD) and stroke, both subsets of CVD, are the world's biggest killers, accounting for a combined 15 million deaths in 2015. These diseases have remained the leading causes of death globally in the last 15 years. In 2010, CAD alone was projected to cost the U.S. $108.9 billion including the cost of health-care services, medications, and lost productivity. The presence of frailty signiicantly worsens outcomes for patients sufering from CAD. With just this one example of how frailty afects CVD, it is clear that understanding the impact of frailty upon patients alicted with the spectrum of cardiovascular disease is integral for the care of this very signiicant patient population.

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“…10,11 This biologic syndrome, which results in decreased resistance to stressors and increased vulnerability to morbidity, has been termed frailty. 12 …”

Section: Introductionmentioning

confidence: 99%

An Accumulated Deficits Model Predicts Perioperative and Long-term Adverse Events after Carotid Endarterectomy

Sridharan¹,

Chaer²,

Wu³

et al. 2018

Annals of Vascular Surgery

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Background There is increasing recognition that decreased reserve in multiple organ systems, known as accumulated deficits (AD), may better stratify perioperative risk than traditional risk indices. We hypothesized that an AD model would predict both perioperative adverse events and long-term survival after carotid endarterectomy (CEA), particularly important in asymptomatic patients. Methods Consecutive patients undergoing CEA between 1st January 2000 and 31st December 2010 were retrospectively identified. Seven of the deficit items from the Canadian Study of Health and Aging–frailty index (coronary disease, renal insufficiency, pulmonary disease, peripheral vascular disease, heart failure, hypertension, and diabetes) were tabulated for each patient. Predictors of perioperative and long-term outcomes were evaluated using regression analysis. Results About 1,782 CEAs in 1,496 patients (mean age: 71.3 ± 9.3 years, 56.3% male, 35.4% symptomatic) were included. The risk of major adverse events (stroke, death, or myocardial infarction) at 30 days for patients with ≤3 deficits was 2.53% vs. 8.81% for patients with ≥4 deficits (P < 0.001). For patients with ≥5 deficits, the risk was 15.18%. Each additional deficit increased the odds of a 30-day major adverse event and hospital stay >2 days by 1.64 (P < 0.001) and 1.15 (P < 0.001), respectively. In multivariate analysis, the presence of ≥4 deficits was more predictive of perioperative major adverse events (odds ratio [OR] = 3.62, P < 0.001) than symptomatology within 6 months (OR = 1.57, P = 0.08) or octogenarian status (OR = 2.00, P = 0.02). Kaplan-Meier analysis showed significantly decreased survival over time with accumulating deficits (P < 0.001). Patients with ≥4 deficits have a hazards ratio for death of 2.6 compared to patients with ≤3 deficits (P < 0.001). Overall survival is estimated at 79.5% (95% confidence interval [CI]: 0.77–0.82) at 5 years in patients with ≤3 deficits versus 52.4% (95% CI: 0.46–0.58) in patients with ≥4 deficits, respectively. In subgroup analysis of asymptomatic patients, 5-year survival for octogenarian male patients with ≥4 deficits was only 26.8%. For asymptomatic males aged 70–79 years with ≥4 deficits, 5-year survival was 59.9%. Conclusions An AD model is more predictive of perioperative adverse events after CEA than age or symptomatic status. This model remains predictive of long-term survival. In asymptomatic male octogenarians with 4 or more AD, 5-year survival is severely limited.

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Validation of a modified Frailty Index to predict mortality in vascular surgery patients

Cited by 113 publications

References 29 publications

An Accumulated Deficits Model Predicts Perioperative and Long-Term Adverse Events After Carotid Endarterectomy

An Accumulated Deficits Model Predicts Perioperative and Long-Term Adverse Events After Carotid Endarterectomy

Frailty and Cardiovascular Disease

An Accumulated Deficits Model Predicts Perioperative and Long-term Adverse Events after Carotid Endarterectomy

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