Frailty and poor functional status are common in arterial vascular surgical patients and affect postoperative outcomes
Open accessAbstract
OBJECTIVES: Increasing numbers of older people are undergoing emergency and elective arterial vascular procedures. Many older patients are frail which is a recognised predictor of adverse postoperative outcomes in other surgical specialties. This study in older patients undergoing arterial vascular surgery examined; the prevalence of preoperative frailty; the clinical feasibility of preoperatively measuring frailty and functional status; the association between these characteristics and adverse postoperative outcome. METHODS: Prospective observational study in patients aged over 60 years undergoing elective and emergency arterial vascular surgery. Baseline measures of frailty (Edmonton Frail Scale), functional status (gait velocity, timed up and go, hand grip strength) and cognitive function (Montreal Cognitive Assessment) were obtained preoperatively. The primary outcome measure Length of Stay (LOS) and secondary outcome measures of postoperative morbidity (medical and surgical complications), functional status and postoperative in-hospital mortality were recorded. RESULTS: 125 patients were recruited. Frailty was common in this older surgical population (52% EFS score of ≥ 6.5) with high frailty scores observed (mean EFS 6.6, SD 3.05) and poor functional status (60% had TUG > 15 s, 45% had gait velocity of < 0.6 m/s). Higher preoperative EFS (> 6.5) was univariately associated with longer LOS (≥ 12 days), composite measures of postoperative infections, postoperative medical complications and adverse functional outcomes. EFS ≥ 6.5 was predictive of LOS ≥ 12 days, adjusted for age (AUC 0.660, CI 0.541-0.779, p = 0.010). This association between EFS ≥ 6.5 and LOS ≥ 12 days was strengthened with the addition of MoCA < 24 (AUC 0.695, CI 0.584-0.806, p = 0.002). CONCLUSIONS: Patients aged over 60 years admitted for arterial vascular surgery were frail, had impaired functional status and were cognitively impaired. This combination of preoperative characteristics was predictive of longer hospital length of stay and associated with adverse postoperative outcome.
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Frailty increases hospital length of stay and adverse outcomes in patients admitted for CVD, HF, CAD, and associated procedures and exacerbates risks of long-term disability thereafter.
“Frailty increases hospital length of stay and adverse outcomes in patients admitted for CVD, HF, CAD,41 and associated procedures (eg, cardiac valve replacement or arterial vascular surgery [aortic or lower limb arterial intervention])45,46 and exacerbates risks of long-term disability thereafter.”
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- Authors
- Partridge, J. S. L., Fuller, M., Harari, D., Taylor, P. R., Martin, F. C., & Dhesi, J. K.
- Affiliations
- St Thomas' Hospital (GB)
- Corresponding author
- Partridge, Judith S.L.
- Venue
- International Journal of Surgery
- Published
- 2015-06
- Volume
- 18
- Pages
- 57-63
- ISSN
- 1743-9159 (ISSN-L)
- 1743-9191
- OpenAlex
- W2121566433
- Cited by
- 160
- References
- 39
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 11 · 2023: 9 · 2022: 18 · 2021: 21 · 2020: 20 · 2019: 24 · 2018: 17 · 2017: 11 · 2016: 12 · 2015: 4
- FWCI
- 7.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- International Journal of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Surgery › Hip and Femur Fractures
- Keywords
- frailty, functional status, elderly patients, postoperative outcomes, length of hospital stay, postoperative complications, postoperative mortality, cognitive impairment, Montreal Cognitive Assessment, Edmonton Frail Scale, walking speed, Timed Up and Go test, grip strength, preoperative frailty assessment
- MeSH terms
- Aged, Aged, 80 and over, Female, Health Services for the Aged, Humans, Length of Stay, London, Male, Middle Aged, Postoperative Complications, Postoperative Period, Prospective Studies, Risk Factors, State Medicine, Vascular Surgical Procedures, Geriatric Assessment, Prevalence, Frail Elderly, Hospital Mortality, Outcome Assessment, Health Care, Elective Surgical Procedures, Hand Strength
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