Association of Frailty Score and Surgical Site Infection After Open Lower Extremity Revascularization

Surgical site infection (SSI) after lower extremity procedures is a persistent source of significant morbidity for vascular surgery patients. Frailty scores capture risk factors for postoperative outcomes associated with SSI. This study aimed to retrospectively evaluate the association between SSI and a validated measure of frailty, the Vascular Quality Initiative-Risk Analysis Index (VQI-RAI).

A retrospective review was performed of patients who underwent open lower extremity revascularization at a single independent academic medical center from January 1, 2007, through December 31, 2019. Frailty score was calculated using VQI-RAI, a composite score based on patient demographic and clinical variables. VQI-RAI scores were compared between patients who developed SSI and those who did not. SSI outcomes were compared between patients defined as frail (VQI-RAI ≥ 35) and not frail (VQI-RAI <  35).

The study population comprised 1130 patients. The overall SSI rate was 8.1%. The median VQI-RAI score was 29 for patients with SSI and 28 for patients without SSI (P = 0.4). No significant association was observed between VQI-RAI and SSI or between patients defined as frail and not frail. Of the individual components of the VQI-RAI score, only body mass index was significantly associated with SSI (P <  .0001).

VQI-RAI frailty score was not associated with risk of SSI in our study population; however, body mass index was significantly associated with SSI. Obesity poses a high risk of SSI, whereas frailty alone may not be associated with an increased risk of SSI.