Frailty and risk in proximal aortic surgery

Area of Science:

• Cardiovascular Surgery
• Geriatric Medicine
• Surgical Outcomes Research

Background:

• Frailty is an emerging predictor of morbidity and mortality across various populations.
• The impact of frailty on outcomes following thoracic aortic surgery remains understudied.

Purpose of the Study:

• To investigate the predictive value of frailty for postoperative morbidity and mortality in patients undergoing proximal aortic replacement surgery.

Main Methods:

• Retrospective analysis of 574 patients undergoing proximal aortic operations (June 2005-December 2012).
• A 6-component frailty index (age >70, low BMI, anemia, stroke history, hypoalbuminemia, low psoas volume) was used; frailty defined as a score ≥2.
• Multivariate regression models assessed outcomes including length of stay, discharge disposition, 30-day composite morbidity/mortality, and 30-day/1-year mortality.

Main Results:

• 148 patients (25.7%) were identified as frail (frailty score ≥2).
• Frail patients had significantly worse unadjusted 30-day/in-hospital and long-term outcomes, except for 30-day readmission rates.
• A frailty score ≥2 independently predicted discharge to other than home, and 30-day and 1-year mortality.

Conclusions:

• A 6-component frailty index effectively predicts discharge disposition and early/late mortality after proximal aortic surgery.
• These easily assessed preoperative frailty markers aid in patient counseling and risk stratification.
• Frailty is an independent predictor of adverse outcomes in this surgical cohort.