Frailty still strongly linked to mortality after EVAR for AAA

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An analysis of the Vascular Quality Initiative (VQI) endovascular aneurysm repair (EVAR) registry for elective abdominal aortic aneurysms (AAAs) revealed that frailty continues to be highly correlated with mortality after the procedure among those aged 80 and over.

Researchers from the Mayo Clinic in Rochester, Minnesota, found EVAR to be safe in low-frailty octogenarians—but among their high-frailty contemporaries the risk of rupture “should be high” prior to the consideration of elective repair.

The data was presented by Lily E. Johnston, MD, a vascular surgery fellow at the institution, during the virtual annual meeting of the Midwestern Vascular Surgical Society (MVSS) Sept. 9–12.

Johnston noted that octogenarians comprise nearly 20% of elective AAA repairs in a recent series, bearing increased perioperative and one-year mortality.

“We know that treatment of aneurysmal disease must be evaluated in the context of overall life expectancy versus risk of rupture,” she said. “Frailty is strongly associated with perioperative and long-term mortality after EVAR in octogenarians.”

The research team aimed to assess how frailty impacts outcomes among patients of advanced age undergoing elective endovascular AAA repair.

Frailty scores were calculated using the modified frailty index, with low-, moderate-, and high-risk groups created on the basis of the 0–25th, 26th–75th, and 76th–99th percentile distributions of the score. Primary outcomes were 30-day and one-year mortality.

The frailty index was calculated for a total 8,462 over the age of 80 who underwent repair.

Scores ranged from 26 to 56 with a median of 31. Patients with a score less than 30 were classed as low frailty, 30-34 moderate, and 35 or over high.

There was no difference noted across groups in intraoperative complications or early re-operation, Johnston said. “However, significant differences across groups were noted in postoperative complications, in which 10% of high-frailty patients had complications such as hematoma, myocardial infarction, stroke and others, versus 7.7% and 7% of moderate- and low-frailty patients, respectively.”

Furthermore, 30-day mortality was 2.7% in the high-frailty group versus 1.1% and 0.8% in the moderate- and low-frailty groups. Meanwhile, one-year mortality was 13.6% among the the high frailty patients, 6.8% in the moderate group, and 4% in the low-frailty class.

Concluding, Johnston told the MVSS gathering: “In low-frailty individuals, EVAR is safe. However, for high-frailty patients, the risk of rupture should be high prior to considering elective repair given the significantly worse postoperative outcomes.”

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