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McKinlay J, Ng A, Nagappan L. Frailty Is Associated With Increased Care Dependence in Patients Following Major Vascular Surgery. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00546-9. [PMID: 39278734 DOI: 10.1053/j.jvca.2024.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/07/2024] [Accepted: 08/18/2024] [Indexed: 09/18/2024]
Abstract
OBJECTIVE To assess if frailty scoring can predict increased frailty and care dependence requiring a change in living situation in patients with peripheral artery disease (PAD) following major vascular surgery. DESIGN A single center, retrospective cohort study. SETTING Fiona Stanley Hospital, a tertiary center located in Perth, Western Australia. PARTICIPANTS Seventy-nine patients with PAD who underwent major vascular surgery at the study hospital in 2022 were enrolled. INTERVENTION Baseline Clinical Frailty Scale (CFS) scores were assigned retrospectively. A quantitative analysis using two partitions, CFS 1-3 (not frail) versus 4-9 (frail) was used. Cases were screened for hospital-acquired complications, and records were reviewed to assess the level of care dependence at the time of discharge and 6 months following. MEASUREMENTS AND MAIN RESULTS The primary outcome was to assess if frailty predicts increased care dependence. Secondary outcomes included unplanned readmissions and hospital-acquired complications in this cohort. A logistic regression was performed to predict the effects of age and baseline, discharge, and 6-month CFS on the likelihood of change in living situation. Baseline frailty was associated with a higher frailty score at discharge (p = 0.001), which persisted at 6 months (p = 0.001). There was no difference in American Society of Anesthesiologists classification, sex, age, 30-day mortality, or in-hospital complications between groups. After correcting for age, a lower baseline CFS (odds ratio 0.19, confidence interval 0.04-0.84, p = 0.028) and discharge CFS (odds ratio 34.00, confidence interval 3.88-298.42, p = 0.001) predicts the likelihood of patients having a change in living situation after surgery. CONCLUSIONS Frail patients with PAD undergoing major vascular surgery are at significant risk of functional decline, necessitating a change in living situation to meet their increased care needs. This increased care dependence persisted 6 months following discharge.
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Affiliation(s)
- Judith McKinlay
- South Metropolitan Health Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
| | - Aloysius Ng
- South Metropolitan Health Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Leena Nagappan
- South Metropolitan Health Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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Findley BL, Holeman TA, Brooke BS. Sex Differences in Patient-Reported Depression Following Vascular Surgery Procedures. J Surg Res 2024; 301:54-61. [PMID: 38917574 PMCID: PMC11427159 DOI: 10.1016/j.jss.2024.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 06/27/2024]
Abstract
INTRODUCTION Female patients frequently experience worse clinical outcomes than male patients after undergoing vascular surgery procedures. However, it is unclear whether these sex-based disparities also impact mental health outcomes. This study was designed to investigate sex differences in patient-reported outcome measures of depression for patients undergoing vascular surgery. METHODS We retrospectively analyzed 107 patients (73 males and 34 females) who underwent vascular surgery procedures between January 2016 and April 2023. These patients completed a Patient-Reported Outcome Measurement Information System (PROMIS) Item Bank v1.0-Depression assessment 90 d before surgery and at least once after surgery. After stratifying patients by sex, we analyzed changes in PROMIS depression scores using a multiple mixed-effects linear regression model. Then, logistic regression was used to compare the proportion of patients who achieved a clinically meaningful difference in PROMIS depression score within 15 mo after surgery. RESULTS There was no significant difference between female and male patients among rates of complications, length of hospital stay, or rates of nonhome discharge. However, female sex was associated with significantly improved PROMIS depression scores after surgery compared to male sex (P = 0.034). Furthermore, female patients were over 3-fold more likely than male patients to reach the minimal clinically important difference threshold for improvement in PROMIS depression scores (odds ratio 4.66, 95% confidence interval 1.39-15.61). CONCLUSIONS These results suggest that female sex is associated with improved patient-reported measures of depression after undergoing vascular surgery. Clinicians should consider these mental health benefits when evaluating female patients for vascular interventions.
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Affiliation(s)
- Blake L Findley
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Teryn A Holeman
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah; Department of Population Health Science, University of Utah Health, Salt Lake City, Utah
| | - Benjamin S Brooke
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah; Department of Population Health Science, University of Utah Health, Salt Lake City, Utah.
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3
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Vaccarino R, Wachtmeister M, Karelis A, Marinko E, Sun J, Resch T, Sonesson B, Dias NV. The role of CT-assessed sarcopenia and visceral adipose tissue in predicting long-term survival in patients undergoing elective endovascular infrarenal aortic repair. Br J Radiol 2024; 97:1461-1466. [PMID: 38848475 PMCID: PMC11256935 DOI: 10.1093/bjr/tqae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/22/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVES To evaluate if ileo-psoas muscle size and visceral adipose tissue (VAT) can predict long-term survival after endovascular aneurysm repair (EVAR). METHODS Patients who underwent EVAR between 2004 and 2012 in a single centre were included. Total psoas muscle area (TPA), abdominal VAT area, subcutaneous adipose tissue (SAT), and total adipose tissue were measured on the preoperative CT. Primary endpoint was all-cause mortality. Values are presented as median and interquartile range or absolute number and percentage. Cox regression analyses were performed to assess the associations with mortality. RESULTS Two hundred and eighty-four patients could be included in the study. During a median follow-up of 8 (4-11) years, 223 (79.9%) patients died. Age (P ≤ .001), cardiovascular (P = .041), cerebrovascular (P = .009), renal diseases (P = .002), and chronic obstructive pulmonary disease (P ≤ .001) were independently associated with mortality. TPA was associated with mortality in a univariate (P = .040), but not in a multivariate regression model (P = .764). No significant association was found between mortality and TPA index (P = .103) or any of the adiposity measurements with the exception of SAT (P = .040). However, SAT area loss in a multivariate analysis (P = .875). CONCLUSIONS Assessment of core muscle size and VAT did not contribute to improving the prediction of long-term survival after EVAR. ADVANCES IN KNOWLEDGE The finding of this study contradicts the previously claimed utility of core muscle size and VAT in predicting long-term survival after EVAR.
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Affiliation(s)
- Roberta Vaccarino
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
| | | | - Angelos Karelis
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
- Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skane University Hospital, Malmö 21428, Sweden
| | - Elisabet Marinko
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
| | - Jianming Sun
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
| | - Timothy Resch
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
- Department of Vascular Surgery, Rigshospitalet, Copenhagen 2100, Denmark
- Department of Health and Medical Sciences, University of Copenhagen, Copenhagen 2100, Denmark
| | - Björn Sonesson
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
- Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skane University Hospital, Malmö 21428, Sweden
| | - Nuno V Dias
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
- Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skane University Hospital, Malmö 21428, Sweden
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Fereydooni A, Johnson CE, Brooke BS, Arya S. Decision making in the frail vascular surgery patient: A scoping review. Semin Vasc Surg 2024; 37:224-239. [PMID: 39152001 DOI: 10.1053/j.semvascsurg.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 08/19/2024]
Abstract
Increasing evidence highlights the adverse impact of frailty and reduced physiologic reserve on surgical outcomes. Therefore, identification of frailty is essential for older adults being evaluated for vascular surgery procedures. Numerous frailty assessment tools are available to quantify the level of frailty and assist in preoperative decision making for these older patients. This review evaluates traditional and novel frailty metrics for their scientific validation, limitations, and clinical utility in vascular surgery decision-making.
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Affiliation(s)
- Arash Fereydooni
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, Cj350i, MC 5639, Palo Alto, CA, 94304
| | - Cali E Johnson
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT
| | - Benjamin S Brooke
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT
| | - Shipra Arya
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, Cj350i, MC 5639, Palo Alto, CA, 94304; Surgery Service Line, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA.
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Jarosinski M, Kennedy JN, Khamzina Y, Alie-Cusson FS, Tzeng E, Eslami M, Sridharan ND, Reitz KM. Percutaneous thrombectomy for acute limb ischemia is associated with equivalent limb and mortality outcomes compared with open thrombectomy. J Vasc Surg 2024; 79:1151-1162.e3. [PMID: 38224861 PMCID: PMC11032234 DOI: 10.1016/j.jvs.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/23/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Acute limb ischemia (ALI) carries a 15% to 20% risk of combined death or amputation at 30 days and 50% to 60% at 1 year. Percutaneous mechanical thrombectomy (PT) is an emerging minimally invasive alternative to open thrombectomy (OT). However, ALI thrombectomy cases are omitted from most quality databases, limiting comparisons of limb and survival outcomes between PT and OT. Therefore, our aim was to compare in-hospital outcomes between PT and OT using the National Inpatient Sample. METHODS We analyzed survey-weighted National Inpatient Sample data (2015-2020) to include emergent admissions of aged adults (50+ years) with a primary diagnosis of lower extremity ALI undergoing index procedures within 2 days of hospitalization. We excluded hospitalizations with concurrent trauma or dissection diagnoses and index procedures using catheter-directed thrombolysis. Our primary outcome was composite in-hospital major amputation or death. Secondary outcomes included in-hospital major amputation, death, in-hospital reintervention (including angioplasty/stent, thrombolysis, PT, OT, or bypass), and extended length of stay (eLOS; defined as LOS >75th percentile). Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) were generated by multivariable logistic regression, adjusting for demographics, frailty (Risk Analysis Index), secondary diagnoses including atrial fibrillation and peripheral artery disease, hospital characteristics, and index procedure data including the anatomic thrombectomy level and fasciotomy. A priori subgroup analyses were performed using interaction terms. RESULTS We included 23,795 survey-weighted ALI hospitalizations (mean age: 72.2 years, 50.4% female, 79.2% White, and 22.3% frail), with 7335 (30.8%) undergoing PT. Hospitalization characteristics for PT vs OT differed by atrial fibrillation (28.7% vs 36.5%, P < .0001), frequency of intervention at the femoropopliteal level (86.2% vs 88.8%, P = .009), and fasciotomy (4.8% vs 6.9%, P = .006). In total, 2530 (10.6%) underwent major amputation or died. Unadjusted (10.1% vs 10.9%, P = .43) and adjusted (aOR = 0.96 [95% CI, 0.77-1.20], P = .74) risk did not differ between the groups. PT was associated with increased odds of reintervention (aOR = 2.10 [95% CI, 1.72-2.56], P < .0001) when compared with OT, but this was not seen in the tibial subgroup (aOR = 1.31 [95% CI, 0.86-2.01], P = .21, Pinteraction < .0001). Further, 79.1% of PT hospitalizations undergoing reintervention were salvaged with endovascular therapy. Lastly, PT was associated with significantly decreased odds of eLOS (aOR = 0.80 [95% CI, 0.69-0.94], P = .005). CONCLUSIONS PT was associated with comparable in-hospital limb salvage and mortality rates compared with OT. Despite an increased risk of reintervention, most PT reinterventions avoided open surgery, and PT was associated with a decreased risk of eLOS. Thus, PT may be an appropriate alternative to OT in appropriately selected patients.
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Affiliation(s)
| | - Jason N Kennedy
- Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Edith Tzeng
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA; Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Mohammad Eslami
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | | | - Katherine M Reitz
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
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Welsh SA, Pearson RC, Hussey K, Brittenden J, Orr DJ, Quinn T. A systematic review of frailty assessment tools used in vascular surgery research. J Vasc Surg 2023; 78:1567-1579.e14. [PMID: 37343731 DOI: 10.1016/j.jvs.2023.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE Frailty is common in vascular patients and is recognized for its prognostic value. In the absence of consensus, a multitude of frailty assessment tools exist. This systematic review aimed to quantify the variety in these tools and describe their content and application to inform future research and clinical practice. METHODS Multiple cross-disciplinary electronic literature databases were searched from inception to August 2022. Studies describing frailty assessment in a vascular surgical population were eligible. Data extraction to a validated template included patient demographics, tool content, and analysis methods. A secondary systematic search for papers describing the psychometric properties of commonly used frailty tools was then performed. RESULTS Screening 5358 records identified 111 eligible studies, with an aggregate population of 5,418,236 patients. Forty-three differing frailty assessment tools were identified. One-third of these failed to assess frailty as a multidomain deficit and there was a reliance on assessing function and presence of comorbidity. Substantial methodological variability in data analysis and lack of methodological description was also identified. Published psychometric assessment was available for only 4 of the 10 most commonly used frailty tools. The Clinical Frailty Scale was the most studied and demonstrates good psychometric properties within a surgical population. CONCLUSIONS Substantial heterogeneity in frailty assessment is demonstrated, precluding meaningful comparisons of services and data pooling. A uniform approach to assessment is required to guide future frailty research. Based on the literature, we make the following recommendations: frailty should be considered a continuous construct and the reporting of frailty tools' application needs standardized. In the absence of consensus, the Clinical Frailty Scale is a validated tool with good psychometric properties that demonstrates usefulness in vascular surgery.
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Affiliation(s)
- Silje A Welsh
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland; Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland.
| | - Rebecca C Pearson
- Department of Medicine for the Elderly, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Keith Hussey
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Julie Brittenden
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland; Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Douglas J Orr
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland; Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Terry Quinn
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
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DeAngelo MM, Holeman TA, Peacock JB, Smith BK, Kraiss LW, Hales JB, Maloney M, Brooke BS. Impact of frailty on risk of long-term functional decline following vascular surgery. J Vasc Surg 2023; 77:515-522. [PMID: 36007843 PMCID: PMC9868047 DOI: 10.1016/j.jvs.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/06/2022] [Accepted: 08/13/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Frailty is a clinical syndrome associated with slow recovery after vascular surgery. However, the degree and length of functional impairment frail patients experience after surgery is unclear. The objective of this study was to prospectively measure changes in functional status among frail and non-frail patients undergoing a spectrum of different vascular surgery procedures. METHODS Patients consented to undergo elective minor and major vascular surgery procedures at an academic medical center between May 2018 and March 2019 were prospectively identified. Prior to surgery, all patients underwent provider assessment of frailty using the validated Clinical Frailty Scale (CFS), as well as baseline assessment of functional status using the Katz Activities of Daily Living (ADL) index and the Lawton Instrumental Activities of Daily Living (iADL) index. These same instruments were used to evaluate each patient's functional status at 2-weeks, 1-month, 1-year, and 2-year time points following surgery. Changes in iADL and ADL scores among frail (CFS ≥5) and non-frail patients were compared using paired Wilcoxon signed-rank tests and logistic regression models. RESULTS A total of 126 patients were assessed before and after minor (55%) and major (45%) vascular procedures, of which 43 patients (34%) were determined to be frail prior to surgery. Frail patients were older and more likely than non-frail patients to have medical comorbidities including chronic kidney disease, chronic obstructive pulmonary disease, or diabetes (all P < .05). When compared with the non-frail cohort, frail patients had significantly lower ADL and iADL scores before surgery and experienced a greater decline in ability to independently complete ADL and iADL activities after surgery that was sustained at 2 years (P < .05 and P < .001, respectively). After risk-adjustment, frailty was associated with an increased likelihood of decline in ADLs (odds ratio, 5.4; 95% confidence interval, 1.9-15.4; P < .05) and iADLs (odds ratio, 6.3; 95% confidence interval, 2.6-15.1; P < .001) at 2 years following surgery. CONCLUSIONS Frail patients experience a significant decline in ability to perform ADL and iADLs that persists 2 years following vascular surgery. These data highlight the degree of functional decline occurring immediately following surgery, as well as risk for long-term, sustained impairment that should be shared with frail patients before undergoing a procedure.
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Affiliation(s)
- Madeline M DeAngelo
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Teryn A Holeman
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Jordan B Peacock
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Brigitte K Smith
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Larry W Kraiss
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Julie B Hales
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Maria Maloney
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Benjamin S Brooke
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT.
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Chen S, Dunn R, Jackson M, Morley N, Sun J. Frailty score and outcomes of patients undergoing vascular surgery and amputation: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1065779. [PMID: 36798484 PMCID: PMC9928186 DOI: 10.3389/fcvm.2023.1065779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction Frailty is associated with adverse postoperative health outcomes, including increased mortality, longer length of stay, higher rehospitalization, and other complications. There are many frailty assessment tools are to assess the level of frailty in vascular surgery patients. The aim of this study was to perform a systematic review and meta-analysis to assess the association between the frailty levels described by different frailty scores and adverse postoperative health outcomes among hospitalized vascular surgery patients and patients undergoing amputation. Methods Studies utilizing frailty scores and similar frailty assessment tools to describe frailty and investigate the association between frailty and health outcomes were searched. The primary outcomes of this study were in-hospital mortality, postdischarge mortality, length of hospital stay, rehospitalization, and discharge location. Additional outcomes included postoperative myocardial infarction, postoperative renal failure, cerebrovascular accident and stroke, comorbidities, and estimated glomerular filtration rate (eGFR) levels. Joanna Briggs Institute (JBI) Critical Appraisal Tools were used for quality assessment. Results In total, 24 studies with 1,886,611 participants were included in the final analysis. The overall results found that higher in-hospital mortality and postdischarge mortality were significantly associated with frailty. Frailty was also found to be significantly associated with a longer length of hospital stay, higher rehospitalization, and higher likelihood of non-home discharge. In addition, the results also showed that frailty was significantly associated with all kinds of comorbidities investigated, except chronic kidney disease. However, lower eGFR levels were significantly associated with frailty. Conclusion Among patients who underwent all types of vascular surgery and those who underwent amputations, assessment of frailty was significantly associated with adverse postoperative outcomes and multiple comorbidities. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=336374, identifier CRD42022336374.
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Affiliation(s)
- Shujie Chen
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Riley Dunn
- School of Pharmacy and Medical Sciences, Griffith University, Nathan, QLD, Australia
| | - Mark Jackson
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia,Department of Vascular Surgery, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Nicola Morley
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia,Department of Vascular Surgery, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Jing Sun
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia,Institute for Integrated and Intelligent Systems, Griffith University, Gold Coast, QLD, Australia,*Correspondence: Jing Sun,
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Holeman TA, Groberg J, Beckstrom JL, Brooke BS. Patient Reported Physical Function as a Preoperative Predictor of Recovery After Vascular Surgery. J Vasc Surg 2022; 76:564-571.e1. [DOI: 10.1016/j.jvs.2022.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/06/2022] [Indexed: 11/27/2022]
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10
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Than TNH, Nguyen T, Nguyen TTT, Pham T. Frailty and Adverse Outcomes Among Older Patients Undergoing Gastroenterological Surgery in Vietnam. J Multidiscip Healthc 2021; 14:2695-2703. [PMID: 34594108 PMCID: PMC8478420 DOI: 10.2147/jmdh.s332986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/09/2021] [Indexed: 02/01/2023] Open
Abstract
Purpose With the ageing population, more older adults undergo surgery, and frailty increases the risk of postoperative complications in older patients. This study aimed to determine the association between frailty and 30-day adverse outcomes in older patients undergoing gastroenterological surgery in Vietnam. Patients and Methods A prospective cohort study was conducted in the Gastroenterology Department of the University Medical Center in Ho Chi Minh City. Frailty was determined using Fried's criteria. Adverse outcomes within 30 days of gastroenterological surgery were recorded, including postoperative infections, acute respiratory failure, acute kidney injury, and death. Univariate and multivariate logistic analyses were performed to determine the association between frailty and 30-day postoperative adverse outcomes using Stata 14.0. Results Data of 302 elective surgical participants were collected (mean age: 69.8± 8.1 years, 53.3% female), and the prevalence of frailty was 18.5%. Frailty was an independent risk factor for 30-day adverse outcomes (odds ratio=6.56, 95% confidence interval, 2.77-15.53, p<0.001), which included postoperative infections, acute respiratory failure, acute kidney injury, and death. Frail participants had a significantly higher risk of postoperative infections (odds ratio=8.21, 95% confidence interval, 3.28-20.54, p<0.001), and exhaustion was strongly associated with postoperative adverse outcomes. Conclusion Frailty was a predictor of 30-day adverse outcomes in older patients undergoing gastroenterological surgery. Therefore, preoperative frailty should be screened in older patients, and frailty-associated risks should be considered during the decision-making process by physicians, patients, and their families.
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Affiliation(s)
- The Ngoc Ha Than
- Department of Geriatrics, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Department of Geriatrics-Palliative Care, Ho Chi Minh City University Medical Center, Ho Chi Minh City, Vietnam
| | - Thien Nguyen
- Department of Cardiology, 115 People's Hospital, Ho Chi Minh City, Vietnam
| | - Tran To Tran Nguyen
- Department of Geriatrics, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Department of Geriatrics, Gia Dinh People's Hospital, Ho Chi Minh City, Vietnam
| | - Tai Pham
- Department of Geriatrics, Gia Dinh People's Hospital, Ho Chi Minh City, Vietnam.,Department of Traditional Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Mehta A, Patel PB, Bajakian D, Schutzer R, Morrissey N, Malas M, Schermerhorn M, Patel VI. Transcarotid Artery Revascularization Versus Carotid Endarterectomy and Transfemoral Stenting in Octogenarians. J Vasc Surg 2021; 74:1602-1608. [PMID: 34082003 DOI: 10.1016/j.jvs.2021.05.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 05/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Transfemoral carotid artery stenting (TFCAS) has higher combined stroke and death rates in elderly patients with carotid artery stenosis compared with carotid endarterectomy (CEA). However, transcarotid artery revascularization (TCAR) may have similar outcomes to CEA. This study compared outcomes after TCARs relative to those after CEAs and TFCAS, focusing on elderly patients. METHODS We included all patients with carotid artery stenosis, and no prior endarterectomy or stenting, who underwent either a CEA, TFCAS, or TCAR in the Vascular Quality Initiative from September 2016 (TCAR commercially available) to December 2019. We categorized patients into age decades: 60-69 years, 70-79 years, and 80-90 years. Outcomes included 30-day and one-year composite rates of stroke or death. Cox-proportional hazards models evaluated both outcomes after adjusting for patient demographics, clinical factors, symptomatology, hospital CEA volume, and clustering. RESULTS We identified 33,115 patients who underwent either a CEA, TFCAS, or TCAR for carotid artery stenosis (35% in their 60s, 44% in their 70s, and 21% in their 80s), where half (50%) were symptomatic. The majority of patients had CEAs (80%), followed by TFCAS (11%) and then TCARs (9.1%). The overall rate of 30-day stroke/death was 1.5% and of one-year stroke/death was 4.4%. Octogenarians had the highest 30-day and one-year stroke/death rates relative to their peers (2.3% and 6.3%, respectively). Among all patients, the adjusted hazards of TCARs relative to CEAs was similar for 30-day stroke/death (HR 1.10 [95%-CI 0.75-1.62]) and slightly higher for one-year stroke/death (HR 1.34 [1.02-1.76]). Among octogenarians, however, the adjusted hazards of TCARs relative to CEAs was similar for both 30-day stroke/death (HR 1.12 [0.59-2.13]) and one-year stroke/death (HR 1.28 [0.85-1.94]). TFCAS relative to CEAs had higher hazards of both 30-day stroke/death (HR 1.78 [1.10-2.89]) and one-year stroke/death (HR 1.85 [1.35-2.54]) in octogenarians. CONCLUSIONS TCARs had similar outcomes relative to CEAs among octogenarians with respect to 30-day and one-year rates of stroke/death. TCAR may serve as a promising less-invasive treatment for carotid disease in older patients who are deemed high anatomic, surgical, or clinical risk for CEAs.
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Affiliation(s)
- Ambar Mehta
- Section of Vascular Surgery and Endovascular Interventions, NYP-Columbia University Irving Medical Center, New York, NY
| | - Priya B Patel
- Division of General Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Danielle Bajakian
- Section of Vascular Surgery and Endovascular Interventions, NYP-Columbia University Irving Medical Center, New York, NY
| | - Richard Schutzer
- Section of Vascular Surgery and Endovascular Interventions, NYP-Columbia University Irving Medical Center, New York, NY
| | - Nicholas Morrissey
- Section of Vascular Surgery and Endovascular Interventions, NYP-Columbia University Irving Medical Center, New York, NY
| | - Mahmoud Malas
- Division of Vascular and Endovascular Surgery, UC San Diego, San Diego, CA
| | - Marc Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Virendra I Patel
- Section of Vascular Surgery and Endovascular Interventions, NYP-Columbia University Irving Medical Center, New York, NY.
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12
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Houghton JS, Nickinson AT, Helm JR, Dimitrova J, Dubkova S, Rayt HS, Gray LJ, Haunton VJ, Davies RS, Sayers RD. Associations of Clinical Frailty with Severity of Limb Threat and Outcomes in Chronic Limb-threatening Ischaemia. Ann Vasc Surg 2021; 76:406-416. [PMID: 33951523 DOI: 10.1016/j.avsg.2021.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/25/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Investigate the relationship of frailty and severity of chronic limb-threatening ischaemia (CLTI), and their comparative associations with one-year outcomes, in patients presenting to a vascular limb salvage (VaLS) clinic. METHODS This retrospective cohort study utilised data collected from a prospectively maintained VaLS clinic database. Patients aged ≥50 presenting to the VaLS clinic with CLTI between February 2018 and April 2019 were included. Frailty was measured using the Clinical Frailty Scale (CFS) and limb threat severity by the Wound, Ischaemia, and foot Infection (WIfI) score. Excessive polypharmacy was defined as ≥10 medications. Anticholinergic burden (ACB) score and Charlson comorbidity index (CCI) were calculated for all patients. The primary outcome measure was a composite endpoint of death or amputation at one-year. Associations with outcome were assessed using Cox regression and reported as hazards ratios (HR) with 95% confidence intervals (CI). RESULTS A total of 198 patients were included, with CFS scores available for 190 patients. 98 patients (52%) were frail (CFS ≥5). 127 patients (67%) initially underwent endovascular revascularisation. Excessive polypharmacy was common (55 patients; 28%). Frailty was associated with increased WIfI stage (P = 0.025) as well as age, female sex, CCI score, number of medications, excessive polypharmacy but not ACB score. Frail patients were more frequently managed non-operatively (P = 0.017). Frailty (HR 1.91; 95% CI 1.09, 3.34; P = 0.024) and WIfI stage 4 (HR 3.29; 95%CI 1.23, 8.80; P = 0.018) were associated with death or amputation on univariable analysis. WIfI stage 4 (HR 2.80; 95%CI 1.04, 7.57; P = 0.042) and CCI score (HR 1.21; 95%CI 1.03, 1.41; P = 0.015), but not frailty (HR 1.25; 95%CI 0.67, 2.33; P = 0.474), were independently associated with death or amputation on multivariable analysis. CONCLUSIONS Frailty is highly prevalent among CLTI patients and related to severity of limb threat. The CFS may be a useful adjunct to patient risk assessment in CLTI.
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Affiliation(s)
- John Sm Houghton
- Department of Cardiovascular Sciences, University of Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, UK; National Institute for Health Research Leicester Biomedical Research Centre - The Glenfield Hospital, Leicester, UK.
| | - Andrew To Nickinson
- Department of Cardiovascular Sciences, University of Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, UK; National Institute for Health Research Leicester Biomedical Research Centre - The Glenfield Hospital, Leicester, UK
| | - Jessica R Helm
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, UK
| | - Jivka Dimitrova
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, UK
| | - Svetlana Dubkova
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, UK
| | - Harjeet S Rayt
- Department of Cardiovascular Sciences, University of Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, UK
| | | | - Robert Sm Davies
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, UK
| | - Rob D Sayers
- Department of Cardiovascular Sciences, University of Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, UK; National Institute for Health Research Leicester Biomedical Research Centre - The Glenfield Hospital, Leicester, UK
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13
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DeAngelo MM, Peacock JB, Holeman TA, Maloney M, Beckstrom J, Brooke BS. Long-Term Functional Decline Following Vascular Surgery Among Vulnerable Adults. Ann Vasc Surg 2021; 76:87-94. [PMID: 33895257 DOI: 10.1016/j.avsg.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/06/2021] [Accepted: 04/10/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Identification of high-risk patients that may experience functional decline following surgery poses a challenge to healthcare providers. The Vulnerable Elders Survey (VES-13) is a patient-reported tool designed to identify risk for health deterioration based on age, self-rated health, physical function, and functional disabilities. This study was designed to determine whether VES-13 could predict long-term functional decline among patients undergoing vascular surgery procedures. METHODS Vascular surgery patients at an academic hospital were administered VES-13 between May 2018 and March 2019, and those scoring ≥3-points were classified as vulnerable. Each patient's functional status was assessed using the Katz Activities of Daily Living (ADL) and the Lawton-Brody Instrumental Activities of Daily Living (iADL) indices preoperatively and at 2-week, 1-month, and 1-year postoperative time points. Logistic regression models were used to identify independent predictors of functional decline. RESULTS 126 patients (59% male) were assessed before and after minor (56%) and major (44%) vascular procedures, with 55 (43%) meeting criteria for vulnerability. Vulnerable patients were older, had lower baseline functional status, and were more likely than non-vulnerable patients to experience declines in ADLs and iADLs at all time-points (P < 0.05 for all time points). These findings were confirmed in risk-adjusted regression models where vulnerability was associated with an increased likelihood of decline in ADLs (OR:3.3; 95%CI:1.0-10.6; P < 0.05) and iADLs (OR:2.6; 95%CI:1.0-6.6; P = 0.05) at 1-year following surgery. CONCLUSION The patient-reported VES-13 survey identifies vulnerable patients who are at risk for long-term functional decline following vascular surgery. This quick preoperative screening tool can allow surgeons to prepare older patients and caretakers for postoperative functional limitations.
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Affiliation(s)
- Madeline M DeAngelo
- Division of Vascular Surgery, University of Utah, School of Medicine, Salt Lake City, UT
| | - Jordan B Peacock
- Division of Vascular Surgery, University of Utah, School of Medicine, Salt Lake City, UT
| | - Teryn A Holeman
- Division of Vascular Surgery, University of Utah, School of Medicine, Salt Lake City, UT
| | - Maria Maloney
- Division of Vascular Surgery, University of Utah, School of Medicine, Salt Lake City, UT
| | - Julie Beckstrom
- Division of Vascular Surgery, University of Utah, School of Medicine, Salt Lake City, UT
| | - Benjamin S Brooke
- Division of Vascular Surgery, University of Utah, School of Medicine, Salt Lake City, UT.
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