Frailty, Glasgow Aneurysm Score, and Intraoperative Factors in Predicting Early Outcomes after Elective Abdominal...

Accurate preoperative risk stratification in patients undergoing elective abdominal aortic aneurysm (AAA) repair remains challenging. Traditional risk scores such as the Glasgow aneurysm score (GAS) rely primarily on static clinical variables and may inadequately reflect physiological reserve. Frailty indices and pulmonary function measures have emerged as potential adjuncts, but their predictive value in contemporary AAA populations is unclear.

We conducted a single-center cohort study including 504 patients undergoing elective AAA repair between November 2019 and December 2024. Patients were treated with open repair (OR; n = 331) or endovascular aneurysm repair (EVAR; n = 173). The five-factor modified frailty index (mFI-5), GAS, and preoperative pulmonary function (FEV₁/FVC ratio) were assessed. Primary outcomes were 30-day mortality and postoperative morbidity; secondary outcomes included delayed extubation. Multivariable logistic regression and receiver operating characteristic analyses were performed; however, mortality analyses were primarily descriptive due to the low number of events.

Overall, 30-day mortality was low (1.4%; EVAR 1.2%, OR 1.5%), precluding meaningful multivariable analysis and identification of reliable predictors of death. Neither GAS nor mFI-5 was associated with mortality. Higher mFI-5 was associated with increased postoperative morbidity despite identical median values between groups (median = 2; P = 0.036), with each one-point increase in mFI-5 associated with a higher risk of complications (OR ≈ 1.34; P = 0.023). GAS was not associated with postoperative complications. In contrast, suprarenal clamping or short neck anatomy and increased intraoperative blood loss were the strongest independent predictors of morbidity and prolonged ventilation. Preoperative FEV₁/FVC ratio was not independently associated with postoperative complications or ventilation duration.

In this contemporary cohort with low perioperative mortality, GAS demonstrated limited predictive value for early outcomes after elective AAA repair. The mFI-5 was associated with postoperative morbidity but not with prolonged ventilation and should be used only as an adjunctive risk assessment tool. Anatomical and intraoperative factors-particularly neck anatomy and blood loss-remain the principal determinants of early postoperative outcomes.