The effect of frailty on long-term outcomes in vascular surgical patients

Objective: Frailty is a multi-dimensional vulnerability due to age-associated decline. We assessed the impact of frailty on long-term outcomes in a cohort of vascular surgical patients.
Methods: Patients aged over 65 years with length of stay (LOS) > 2 days admitted to a tertiary vascular unit over a single calendar year were included. Demographics, mode of admission, diagnosis were recorded alongside a variety of frailty-specific characteristics. Using the previously developed Addenbrookes Vascular Frailty Score (AVFS – 6 point score: anaemia on admission, lack of independent mobility, polypharmacy , Waterlow score > 13, depression and emergency admission) we assessed the effect of frailty on 5-year mortality and readmission rates using multivariate regression techniques. We further refined the AVFS to assess longer term outcomes.
Results: In total, 410 patients (median age 77 years) were included and followed up until death or five years since the index admission. One hundred and thirty-four were treated for aortic aneurysm, 75 and 96 for acute and chronic limb ischaemia respectively, 52 for carotid disease and 53 for other pathologies. The in-hospital mortality rate was 3.6%. The 1-, 3- and 5-year survival rates were 83%, 70% and 59%; and the 1-, 3- and 5-year readmission-free survival rates were 47%, 29% and 22% respectively. Independent predictors of 5-year mortality were age, lack of independent mobility, high Charlson score, polypharmacy, evidence of malnutrition and emergency admission (P<0.01 for all). Patients with AVFS 0 or 1 had restricted mean survival times which were 1 year longer than those with AVFS 2 or 3 (P<0.0001), who in turn had restricted mean survival times over 1 year longer than those with AVFS of 4 or more (P<0.0001).
Conclusions: Frailty factors are strong predictors of long-term outcomes in vascular surgery. Further prospective studies are warranted to investigate its utility in clinical decision-making.