Higher frailty scores linked to increased postoperative complications and mortality in veterans undergoing EVAR for AAA

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Wayne Tse speaks from the podium at SCVS 2021

Higher frailty scores were associated with higher rates of postoperative complications and mortality among a national cohort of veteran patients who underwent endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) or dissection. This was one of the findings of a retrospective analysis of the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database using the Risk Analysis Index (RAI). 

The data were presented by Wayne Tse, MD, a resident in the department of surgery at Virginia Commonwealth University in Richmond, Virginia, at the Society for Clinical Vascular Surgery (SCVS) Annual Symposium (March 13–17), held as a hybrid meeting from Miami.

Opening his presentation, entitled “Using the Risk Analysis Index to assess frailty in a veteran cohort undergoing endovascular aortic aneurysm repair,” Tse pointed to the growing importance of surgical frailty assessment in perioperative management as the elderly share of the population increases.

The RAI tool—calculated from 12 different preoperative variables and weighted risk factors to yield a score between 0–81—previously has been shown “to be associated with worse short- and long-term outcomes in multiple procedures and subspecialties,” Tse said.

The VASQIP database was queried for cases that took place between 2001 and 2018. A total of 5,878 patients who underwent EVAR were identified, with an average age of 71. They were placed into three cohorts: those who were non-frail (classified as a score up to 20), frail (21–34) and very frail (35 and up). Some 36.2% were recorded as non-frail, 56% as frail and 7.7% as very frail.

“More frail patients had more medical comorbidities; more frail patients were also more likely to have cancer and less likely to be independent,” Tse told SCVS 2021. Additionally, they were also more likely to undergo emergent surgery, he added.

“After univariate analysis, we can see the rates of postoperative complications are increasing as the frailty index score is also increasing,” Tse continued.

“There are increasing rates of death, cardiac, pulmonary and renal complications. Frail and very frail patients were up to 7 and 3 times more likely to experience 30-day mortality and a complication within 30 days.”

Tse acknowledged limitations such as the retrospective nature of the data, the fact that the researchers dealt with only 30-day outcomes, and that there were no procedure-specific outcomes.

“Higher frailty scores were associated with higher rates of postoperative complications and mortality. Risk-adjusted scores were also associated with these findings,” he concluded.

“In the future, we hope to use this RAI score to implement and aid in the discussion of postoperative outcomes during the informed consent process.”

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