Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Ann Vasc Surg. 2021 May;73:273-279. doi: 10.1016/j.avsg.2020.10.048. Epub 2020 Dec 17.
Frailty is a common, age-associated syndrome that has been used to predict postoperative outcomes in vascular surgery. This study examines if standard measures of frailty correlate with postoperative outcomes for patients undergoing revascularization for acute limb ischemia (ALI).
A retrospective study was conducted on all adult patients undergoing revascularization for ALI at an academic medical center between January 2016 and June 2019. Frailty was calculated with the 11-factor modified frailty index (mFI-11), derived from the Canadian Study of Health and Aging Frailty Index. Outcomes examined included in-hospital mortality, major amputation, site of discharge, and ambulatory status at follow-up.
Fifty-three ambulatory patients presented with ALI during the study time period, with 13.2% deemed not frail (mFI-11 < 3) and 86.8% deemed frail (mFI-11 ≥ 3). Frailty was significantly correlated with discharge to a skilled nursing facility (P = 0.028) and nonambulation at follow-up (P = 0.002). There was no significant correlation with other outcomes, including mortality and amputation. On multivariate analysis, frailty was the only factor contributing to nonambulation at follow-up (P = 0.012). Endovascular treatment did not mitigate the effects of frailty on discharge site and ambulatory status.
Frailty is exceedingly common in patients with ALI. Although frailty predicts discharge site and nonambulation at follow-up, it is not associated with amputation or death. Therefore, frail patients should not be denied open or endovascular revascularization for ALI.
衰弱是一种常见的与年龄相关的综合征，已被用于预测血管外科学术后结果。本研究探讨了在学术医疗中心接受急性肢体缺血（ALI）血运重建的患者中，标准衰弱测量指标与术后结果是否相关。
对 2016 年 1 月至 2019 年 6 月期间在学术医疗中心接受 ALI 血运重建的所有成年患者进行回顾性研究。采用源自加拿大健康老龄化衰弱指数的 11 因素改良衰弱指数（mFI-11）计算衰弱程度。评估的结果包括院内死亡率、大截肢、出院地点和随访时的步行状态。
研究期间共有 53 例可活动的患者出现 ALI，其中 13.2%被认为不衰弱（mFI-11<3），86.8%被认为衰弱（mFI-11≥3）。衰弱与入住疗养院（P=0.028）和随访时不能行走（P=0.002）显著相关。与其他结果（包括死亡率和截肢）无显著相关性。多变量分析显示，衰弱是导致随访时不能行走的唯一因素（P=0.012）。血管内治疗并不能减轻衰弱对出院地点和步行状态的影响。
ALI 患者衰弱非常常见。尽管衰弱预测出院地点和随访时不能行走，但与截肢或死亡无关。因此，不应拒绝衰弱的 ALI 患者进行开放或血管内血运重建。
