Increased Frailty Associated with Higher Long-Term Mortality after Major Lower Extremity Amputation

Area of Science:

• Geriatric Surgery
• Vascular Surgery
• Surgical Outcomes Research

Background:

• Frailty assessments are crucial in preoperative planning for elderly surgical patients.
• Frailty is linked to higher mortality rates in patients undergoing lower extremity amputation.
• This study compares two frailty scores, mFI and RAI, for predicting mortality after amputation.

Purpose of the Study:

• To compare the efficacy of the modified Frailty Index (mFI) and Risk Analysis Index (RAI) in predicting short- and long-term mortality.
• To stratify mortality risk based on frailty status in patients undergoing lower extremity amputation.
• To evaluate the utility of frailty scoring systems in preoperative planning for amputation.

Main Methods:

• Retrospective review of 298 patients undergoing lower extremity amputation (2014-2019) at a Veterans Affairs Medical Center.
• Calculation of mFI and RAI frailty scores using preoperative variables.
• Stratification into non-frail, frail, and very frail cohorts for comparison of 30-day outcomes and mortality.

Main Results:

• Increasing frailty, as measured by both mFI and RAI, was associated with significantly worse short- and long-term mortality.
• At 1-year post-amputation, mortality rates increased substantially with higher frailty levels (e.g., RAI: 8% non-frail to 43% very frail).
• Only length of stay showed association with increasing frailty (mFI) among 30-day outcomes.

Conclusions:

• Preoperative frailty scoring systems (mFI, RAI) are valuable tools for identifying patients at higher risk of mortality after lower extremity amputation.
• Frailty assessment should be considered a standard screening tool for patients with peripheral vascular disease undergoing amputation.
• Understanding frailty status enables a more patient-centered approach to discussing amputation risks and benefits.