1
|
Saucy F, Probst H, Hungerbühler J, Maufroy C, Ricco JB. 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. J Clin Med 2024; 13:1935. [PMID: 38610700 PMCID: PMC11012666 DOI: 10.3390/jcm13071935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- François Saucy
- Service de Chirurgie Vasculaire, Ensemble Hospitalier de la Côte, Hôpital de Morges, 1110 Morges, Switzerland; (H.P.); (J.H.); (C.M.)
| | - Hervé Probst
- Service de Chirurgie Vasculaire, Ensemble Hospitalier de la Côte, Hôpital de Morges, 1110 Morges, Switzerland; (H.P.); (J.H.); (C.M.)
| | - Johan Hungerbühler
- Service de Chirurgie Vasculaire, Ensemble Hospitalier de la Côte, Hôpital de Morges, 1110 Morges, Switzerland; (H.P.); (J.H.); (C.M.)
| | - Coralie Maufroy
- Service de Chirurgie Vasculaire, Ensemble Hospitalier de la Côte, Hôpital de Morges, 1110 Morges, Switzerland; (H.P.); (J.H.); (C.M.)
| | | |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Gan S, Yu Y, Wu J, Tang X, Zheng Y, Wang M, Zhu S. Preoperative assessment of cognitive function and risk assessment of cognitive impairment in elderly patients with orthopedics: a cross-sectional study. BMC Anesthesiol 2020; 20:189. [PMID: 32738902 PMCID: PMC7395982 DOI: 10.1186/s12871-020-01096-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/14/2020] [Indexed: 12/21/2022] Open
Abstract
Background Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. Nevertheless, cognitive impairment in a large proportion of geriatric patients has not been well identified and diagnosed. Methods This is a cross-sectional study. Mini-mental state examination scale was used to assess the cognitive function of elderly patients aged ≥65 years undergoing orthopedic surgery preoperatively. The baseline, living habits and laboratory examination results of two groups were compared, and a multivariable logistic regression model was used to identify independent predictors of preoperative cognitive impairment. Results A total of 374 elderly patients with orthopedic surgery indications met the inclusion criteria, and 28.61% of them had preoperative cognitive impairment. Multivariable logistic regression analysis showed that age (OR = 1.089, P < 0.001), subjective sleep disorders (OR = 1.996, P = 0.021), atherosclerosis (OR = 2.367, P = 0.017), and high cholesterol level (OR = 1.373, P = 0.028) were independent risk factors for preoperative cognitive impairment, while high education level performed as a protective factor (compared with the illiterate group, primary school group: OR = 0.413, P = 0.009; middle school or above group: OR = 0.120, P < 0.001). Conclusions The prevalence of preoperative cognitive dysfunction in geriatric elective orthopedic surgical patients was high. Our study identified venerable age, low level of education, subjective sleep disorders, atherosclerosis, and high cholesterol level as risk factors for preoperative cognitive impairment in these patients. Understanding these risk factors contributes to assisting in prevention and directed interventions for the high-risk population.
Collapse
Affiliation(s)
- Shuyuan Gan
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, China
| | - Yang Yu
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, China
| | - Jiateng Wu
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, China
| | - Xiaodong Tang
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, China
| | - Yueying Zheng
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, China
| | - Mingcang Wang
- Department of Anesthesiology, Taizhou Hospital, Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Shengmei Zhu
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, China.
| |
Collapse
|
4
|
Pettersson ME, Bergbom I. Life is about so much more: Patients' experiences of health, well-being, and recovery after operation of abdominal aortic aneurysm with open and endovascular treatment-A prospective study. JOURNAL OF VASCULAR NURSING 2019; 37:160-168. [PMID: 31727308 DOI: 10.1016/j.jvn.2019.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/31/2019] [Accepted: 06/23/2019] [Indexed: 11/16/2022]
Abstract
Different surgical treatments for abdominal aortic aneurysm can lead to different perceptions of health and well-being. The aim of this study was to describe patients' well-being, sense of coherence (SOC), and experiences of surgery after open and endovascular treatment one month and one and 2 years after the procedure. Seventy six patients participated (40 open repair; 36 endovascular aneurysm repair). The study was conducted using the SOC questionnaire, and specific questions about patients' experiences of the surgical treatment and well-being. After 2 years, no patient regretted the operation or considered it to be the most difficult experience they had ever had. Twenty percent of the patients were worried about complications one month after the operation. Both groups experienced difficulty in returning to normal activity after surgery at one month. At one and 2 years after the surgery, patients in both groups stated that it was other things in life that affected their well-being. The endovascular aneurysm repair group reported a significant decrease in SOC from baseline until one year (P = .012) and 2 years (P = .033). The open repair group reported a significant decrease after one year (0.033). The operation did not affect patients' way of thinking about the disease. Patients in both groups stated that it was other circumstances in life that affected their well-being one and 2 years after the treatment, which could indicate that long-term follow-up would not be necessary from a patient perspective. The operation affects patients' well-being a short time after the operation.
Collapse
Affiliation(s)
- Monica E Pettersson
- Vascular Department, Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Sweden, Göteborg, Sweden.
| | - Ingegerd Bergbom
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden, Göteborg, Sweden
| |
Collapse
|
5
|
Lagergren E, Chihade D, Zhan H, Perez S, Brewster L, Arya S, Jordan WD, Duwayri Y. Outcomes and Durability of Endovascular Aneurysm Repair in Octogenarians. Ann Vasc Surg 2019; 54:33-39. [DOI: 10.1016/j.avsg.2018.08.074] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/24/2018] [Accepted: 08/26/2018] [Indexed: 01/27/2023]
|
6
|
King EG, Farber A, Rybin D, Doros G, Kalish JA, Eslami MH, Siracuse JJ. Preoperative Risk Factors Predict Protracted Hospital Length of Stay after Elective Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2017; 43:73-78. [DOI: 10.1016/j.avsg.2016.12.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 09/27/2016] [Accepted: 12/05/2016] [Indexed: 10/19/2022]
|
7
|
Harris DG, Bulatao I, Oates CP, Kalsi R, Drucker CB, Menon N, Flohr TR, Crawford RS. Functional status predicts major complications and death after endovascular repair of abdominal aortic aneurysms. J Vasc Surg 2017; 66:743-750. [PMID: 28259573 DOI: 10.1016/j.jvs.2017.01.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 01/10/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Endovascular aneurysm repair (EVAR) is considered a lower risk option for treating abdominal aortic aneurysms and is of particular utility in patients with poor functional status who may be poor candidates for open repair. However, the specific contribution of preoperative functional status to EVAR outcomes remains poorly defined. We hypothesized that impaired functional status, based simply on the ability of patients to perform activities of daily living, is associated with worse outcomes after EVAR. METHODS Patients undergoing nonemergent EVAR for abdominal aortic aneurysm between 2010 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. The primary outcomes were 30-day mortality and major operative and systemic complications. Secondary outcomes were inpatient length of stay, need for reoperation, and discharge disposition. Using the NSQIP-defined preoperative functional status, patients were stratified as independent or dependent (either partial or totally dependent) and compared by univariate and multivariable analyses. RESULTS Of 13,432 patients undergoing EVAR between 2010 and 2014, 13,043 were independent (97%) and 389 were dependent (3%) before surgery. Dependent patients were older and more frequently minorities; had higher rates of chronic pulmonary, heart, and kidney disease; and were more likely to have an American Society of Anesthesiologists score of 4 or 5. On multivariable analysis, preoperative dependent status was an independent risk factor for operative complications (odds ratio [OR], 3.1; 95% confidence interval [CI], 2.5-3.9), systemic complications (OR, 2.8; 95% CI, 2.0-3.9), and 30-day mortality (OR, 3.4; 95% CI, 2.1-5.6). Secondary outcomes were worse among dependent patients. CONCLUSIONS Although EVAR is a minimally invasive procedure with substantially less physiologic stress than in open aortic repair, preoperative functional status is a critical determinant of adverse outcomes after EVAR in spite of the minimally invasive nature of the procedure. Functional status, as measured by performance of activities of daily living, can be used as a valuable marker of increased perioperative risk and may identify patients who may benefit from preoperative conditioning and specialized perioperative care.
Collapse
Affiliation(s)
- Donald G Harris
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md.
| | - Ilynn Bulatao
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Connor P Oates
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Richa Kalsi
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Charles B Drucker
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Nandakumar Menon
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Tanya R Flohr
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Robert S Crawford
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Center for Aortic Disease, University of Maryland Medical Center, Baltimore, Md
| |
Collapse
|