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The Modified Frailty Index Does Not Predict Mortality After Major Lower Extremity Amputation for Peripheral Arterial

Reuban Toby D'cruz1, Tze Tec Chong2, Ting Fang Tan3

  • 1Department of General Surgery, National University Hospital, Singapore.

Annals of Vascular Surgery
|June 8, 2020
PubMed

Insights

Frailty, measured by the modified frailty index (mFI), did not predict mortality or complications in patients undergoing major lower extremity amputation (LEA) for critical limb ischemia (CLI). Other factors like kidney disease and heart conditions were more significant predictors of poor outcomes.

Area of Science:

  • Vascular Surgery
  • Geriatric Medicine
  • Health Services Research

Background:

  • Patients with critical limb ischemia (CLI) undergoing major lower extremity amputation (LEA) face high mortality.
  • Western studies identified nonambulatory status and cardiovascular issues as risk factors.
  • This study investigated frailty's predictive value for outcomes in a Singaporean cohort.

Purpose of the Study:

  • To assess the modified frailty index (mFI) as a predictor of mortality, perioperative complications, and readmissions.
  • To evaluate frailty's impact on patients undergoing major LEA for CLI.
  • To identify key risk factors for adverse outcomes in this population.

Main Methods:

  • Retrospective analysis of 211 patients undergoing major LEA (below-knee or above-knee amputation) from 2016-2017.
  • Patients were stratified into low, moderate, and high mFI groups (11-variable index).
  • Logistic regression analysis was used to determine predictors of outcomes.

Main Results:

  • One-year mortality was 39.8%, with no significant difference across mFI groups.
  • Perioperative complications occurred in 43.1% and 30-day readmissions in 12.8% of patients.
  • Myocardial infarction, chronic kidney disease, and atrial fibrillation predicted poor outcomes.

Conclusions:

  • The modified frailty index (mFI) did not predict outcomes after major LEA in this cohort.
  • Confounding factors like high renal dysfunction prevalence and consistent diabetes/PVD limited mFI's predictive utility.
  • Comorbidities such as myocardial infarction, CKD, and AF are significant predictors of adverse events.
Abstract

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