Background
Frailty syndrome is an established predictor of adverse outcomes after carotid surgery.
Recently, a modified 5-factor National Surgical Quality Improvement Program frailty
index has been used; however, its utility in vascular procedures is unclear. The aim
of our study was to compare the 5-factor modified frailty index (mFI-5) with the 11-factor
modified frailty index (mFI-11) regarding value and predictive ability for mortality,
postoperative infection, and unplanned 30-day readmission.
Methods
The mFI was calculated by dividing the number of factors present for a patient by
the number of available factors for which there were no missing data. Spearman rho
test was used to assess the correlation between the mFI-5 and mFI-11. Predictive models,
using both unadjusted and adjusted logistic regressions, were created for each outcome
for carotid endarterectomy using 2005–2012 National Surgical Quality Improvement Program
data, the last year all mFI-11 variables existed.
Results
A total of 36,000 patients were included with mean age of 74.6 ± 5.9 years, complication
rate of 10.7%, mortality rate of 3.1%, and readmission rate of 6.2%. Correlation between
mFI-5 and mFI-11 was above 0.9 across all outcomes for patients. mFI-5 had strong
predictive ability for mortality, postoperative complications, and 30-day readmission.
Conclusions
The mFI-5 and mFI-11 are equally effective predictors of postoperative outcomes in
patients undergoing carotid endarterectomy. mFI-5 is a strong predictor of postoperative
complications, mortality, and 30-day readmission.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic and PersonalCorporate R&D ProfessionalsOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Annals of Vascular SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Changing epidemiology of the American population.Clin Geriatr Med. 2019; 35: 1-12
- Carotid endarterectomy outcomes in the elderly: a Canadian institutional experience.Ann Vasc Surg. 2019; 59: 16-20
- Validation of a modified Frailty Index to predict mortality in vascular surgery patients.J Vasc Surg. 2016; 63: 1595-1601.e2
- Frailty in elderly people.Lancet. 2013; 381: 752-762
- Frailty in older adults: evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M157
- Frailty and post-operative outcomes in older surgical patients: a systematic review.BMC Geriatr. 2016; 16: 157
- Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database.J Surg Res. 2013; 183: 104-110
- Are the frail destined to fail? Frailty index as predictor of surgical morbidity and mortality in the elderly.J Trauma Acute Care Surg. 2012; 72 (discussion 30–31): 1526-1530
- The IANA Task Force on frailty assessment of older people in clinical practice.J Nutr Health Aging. 2008; 12: 29-37
- Physical frailty in older adults is associated with metabolic and atherosclerotic risk factors and cognitive impairment independent of muscle mass.J Nutr Health Aging. 2011; 15: 857-862
- Comparison of frailty indicators based on clinical phenotype and the multiple deficit approach in predicting mortality and physical limitation.J Am Geriatr Soc. 2012; 60: 1478-1486
- Validating a widely used measure of frailty: are all sub-components necessary? Evidence from the Whitehall II cohort study.Age (Dordr). 2013; 35: 1457-1465
- Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women.Arch Intern Med. 2008; 168: 382-389
- Some mathematical models of frailty and their clinical implications.Rev Clin Gerontol. 2002; 12: 109-117
- A global clinical measure of fitness and frailty in elderly people.CMAJ. 2005; 173: 489-495
- New 5-factor modified frailty index using American College of Surgeons NSQIP data.J Am Coll Surg. 2018; 226: 173-181.e8
- A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair.Surg Endosc. 2017; 31: 2509-2519
- The 5-item modified frailty index is predictive of 30-day postoperative complications in patients undergoing kyphoplasty vertebral augmentation.World Neurosurg. 2018; 116: e225-e231
- Use of a 5-item modified frailty index for risk stratification in patients undergoing surgical management of distal radius fractures.J Hand Surg Am. 2018; 43: 701-709
- Ventral hernia repair outcomes predicted by a 5-item modified frailty index using NSQIP variables.Hernia. 2019; 23: 891-898
- Preoperative frailty Risk Analysis Index to stratify patients undergoing carotid endarterectomy.J Vasc Surg. 2015; 61: 683-689
- Simplified frailty index to predict adverse outcomes and mortality in vascular surgery patients.Ann Vasc Surg. 2013; 27: 904-908
- Association of the modified frailty index with 30-day surgical readmission.JAMA. 2017; 152: 749-757
- Frailty increases the risk of 30-day mortality, morbidity, and failure to rescue after elective abdominal aortic aneurysm repair independent of age and comorbidities.J Vasc Surg. 2015; 61: 324-331
- Volume-outcome relationships in vascular surgery: the current status.J Endovasc Ther. 2010; 17: 356-365
- Volume-outcome relationships and abdominal aortic aneurysm repair.Circulation. 2011; 53: 1160
- Failure to rescue and mortality following repair of abdominal aortic aneurysm.J Vasc Surg. 2014; 59: 909-914.e1
Article Info
Publication History
Published online: October 11, 2019
Accepted:
October 2,
2019
Received:
April 10,
2019
Footnotes
Presented as an oral presentation at the Vascular and Endovascular Surgery Society Winter Meeting at Snowbird, Utah, January 31–March 2, 2019.
Conflicts of interest: The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
