Division of Vascular and Endovascular Services, Upstate Medical University, Syracuse, New York; Department of Surgery, Syracuse VA Medical Center, Syracuse, New York.
Division of Vascular and Endovascular Services, Upstate Medical University, Syracuse, New York.
J Surg Res. 2019 Nov;243:539-552. doi: 10.1016/j.jss.2019.06.040. Epub 2019 Aug 1.
Frailty predicts poor outcome after vascular surgery. We determined the predictive utility of the modified frailty index (mFI) after first-time revascularization and identified biomarkers of frailty predictive of outcome in veterans with peripheral arterial disease.
A retrospective study was performed of first-time revascularizations (open surgery [OS] and endovascular surgery [ES]) in male veterans (2003-2016). Preoperative mFI scores were calculated, and serum and nonserum biomarkers of frailty were recorded. The primary endpoint was 2-y incidence of reintervention, amputation, and mortality. Secondary endpoints included 30-day morbidity and readmissions.
Four hundred and thirty one patients (OS, n = 188; ES, n = 243), mean age of 66 ± 9 y, and 16 mo of median follow-up were studied. Mean mFI was 0.39 ± 0.16 for OS and 0.38 ± 0.15 for ES (P = 0.43). 30-day complications (adjusted odds ratio, 4.89; 95% confidence interval [CI]: 1.67-14.33) and readmissions (adjusted hazard ratio [aHR] 3.32; 95% CI: 1.16-9.55) were increased in the OS versus ES group when stratified by mFI. Survival analysis showed a correlation between risk of amputation, death, and composite outcome with increasing mFI (P < 0.005) in both groups. Frailty independently predicted major amputation (aHR 2.16; 1.06-4.39), mortality (aHR 2.62; 95% CI: 1.17-5.88), and composite outcome (aHR 1.97; 95% CI: 1.06-3.68) when the groups are combined. Except for absolute neutrophil count, all preoperative lab values correlated with mFI (P < 0.5). Higher albumin was independently associated with lower risk of amputation (aHR: 0.58 [0.36-0.94]) and mortality (aHR: 0.45 [0.25-0.83]); higher hemoglobin predicted limb salvage (aHR 0.7 [0.62-0.84]).
Frailty predicts short- and long-term outcomes after first-time revascularization in veterans. Hypoalbuminemia and anemia are associated with higher mFI and independently predict poor outcome, suggesting albumin and hemoglobin are viable biomarkers of frailty in veterans.
虚弱预测血管手术后的不良结果。我们确定了改良虚弱指数（mFI）在首次血运重建后的预测效用，并确定了外周动脉疾病退伍军人虚弱的预测生物标志物与结果相关。
对男性退伍军人（2003-2016 年）的首次血运重建（开放手术[OS]和血管内手术[ES]）进行回顾性研究。计算术前 mFI 评分，并记录血清和非血清虚弱生物标志物。主要终点是 2 年再干预、截肢和死亡率。次要终点包括 30 天发病率和再入院率。
研究了 431 例患者（OS，n=188；ES，n=243），平均年龄 66±9 岁，中位随访时间为 16 个月。OS 的平均 mFI 为 0.39±0.16，ES 为 0.38±0.15（P=0.43）。当按 mFI 分层时，OS 组的 30 天并发症（调整优势比，4.89；95%置信区间[CI]：1.67-14.33）和再入院（调整危险比[aHR]3.32；95%CI：1.16-9.55）增加。生存分析显示，两组中，mFI 增加与截肢、死亡和复合结局的风险相关（P<0.005）。虚弱独立预测主要截肢（aHR 2.16；1.06-4.39）、死亡率（aHR 2.62；95%CI：1.17-5.88）和复合结局（aHR 1.97；95%CI：1.06-3.68）当组合时。除了绝对中性粒细胞计数外，所有术前实验室值均与 mFI 相关（P<0.5）。较高的白蛋白独立与较低的截肢风险（aHR：0.58[0.36-0.94]）和死亡率（aHR：0.45[0.25-0.83]）相关；较高的血红蛋白预测肢体存活（aHR 0.7[0.62-0.84]）。
虚弱预测退伍军人首次血运重建后的短期和长期结果。低白蛋白血症和贫血与较高的 mFI 相关，并独立预测不良结局，这表明白蛋白和血红蛋白是退伍军人虚弱的可行生物标志物。
