Frailty accounted for an increased morbidity in elective AAA repair patients who participated in a study detailed in the February 2015 edition of the Journal for Vascular Surgery.
Lead author Dr. Shipra Arya notes that more than 60 percent of vascular procedures are performed on individuals 65 years old or older. It can be difficult to assess the risk level, she writes, because there is not a set of standardized, easily reproducible tools to predict outcomes. Most pre-op risk assessment focuses on cardiac issues, but overall decreased physiologic reserve based on a higher mFI (modified frailty index) score may be associated with a reduced ability to recover from surgery.
“Patient frailty significantly increases the risk of complications and death and should be evaluated in pre-op decision-making and counseling,” explained Dr. Arya. “When we recommend EVAR for patients considering it a low-risk procedure, we still need to assess patient frailty and counsel them on increased risk of complications if they are frail. A frailty index is a way to objectify the ‘eyeball test’ that some surgeons intuitively use, and include it into a formal, pre-op risk stratification.”
The need for more research is immense, she noted, since there are multiple models of frailty and no data on whether frailty can be changed preoperatively to lower surgical risk. She is currently collaborating with other surgeons and geriatricians at Emory University [Drs. Kenneth Ogan, Viraj Master and Theodore M Johnson II], University of Nebraska [Dr. Jason Johanning] and University of Pittsburgh [Dr. Daniel Hall] to determine the most efficacious approach to incorporate frailty assessment into everyday surgical practice.