Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
Division of Vascular Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
Ann Vasc Surg. 2021 Jul;74:111-121. doi: 10.1016/j.avsg.2020.12.039. Epub 2021 Feb 5.
Frailty has been increasingly recognized as an important risk factor for vascular procedures. To assess the impact of frailty on clinical outcomes and resource utilization in patients undergoing carotid revascularization using a national cohort.
The 2005-2017 National Inpatient Sample was used to identify patients who underwent carotid endarterectomy (CEA) or carotid stenting (CAS). Patients were classified as frail using diagnosis codes defined by the Johns Hopkins Adjusted Clinical Groups frailty indicator. Multivariable regression was used to evaluate associations between frailty and in-hospital mortality, postoperative stroke, myocardial infarction (MI), hospitalization costs, and length of stay (LOS).
Of 1,426,343 patients undergoing carotid revascularization, 59,158 (4.2%) were identified as frail. Among frail patients, 79.4% underwent CEA and 20.6% underwent CAS. Compared to CEA, a greater proportion of patients undergoing CAS were frail (6.0% vs. 3.8%, P < 0.001). Compared to the nonfrail cohort, frail patients had higher rates of mortality (2.2% vs. 0.5%, P < 0.001), postoperative stroke (2.6% vs. 1.0%, P < 0.001), MI (2.2% vs. 0.8%, P < 0.001), and stroke/death (4.4% vs. 1.4%, P < 0.001). After adjustment, frailty was associated with increased odds of mortality (AOR = 1.59, 95% CI: 1.30-1.80, P < 0.001), stroke (AOR = 1.66, 95% CI: 1.38-1.83 P < 0.001), MI (AOR = 1.51, 95% CI: 1.29-1.72, P < 0.001), and stroke/death (AOR = 1.62, 95% CI: 1.45-1.81, P < 0.001). Furthermore, frailty was associated with increased hospitalization costs (β = +$5,980, 95% CI: $5,490-$6,470, P < 0.001) and LOS (β = +2.6 days, 95% CI: 2.4-2.8, P < 0.001).
Frailty is associated with adverse outcomes and greater resource use for those undergoing carotid revascularization. Risk models should include an assessment of frailty to guide management and improve outcomes for these high-risk patients.
衰弱已被越来越多地认为是血管手术的一个重要危险因素。本研究旨在利用全国队列评估衰弱对颈动脉血运重建患者临床结局和资源利用的影响。
本研究使用了 2005-2017 年全国住院患者样本，以确定接受颈动脉内膜切除术（CEA）或颈动脉支架置入术（CAS）的患者。使用约翰霍普金斯调整临床组衰弱指标定义的诊断代码将患者归类为衰弱。多变量回归用于评估衰弱与住院死亡率、术后卒中、心肌梗死（MI）、住院费用和住院时间（LOS）之间的关联。
在 1426343 例接受颈动脉血运重建的患者中，有 59158 例（4.2%）被确定为衰弱。在衰弱患者中，79.4%接受 CEA，20.6%接受 CAS。与 CEA 相比，接受 CAS 的患者中衰弱的比例更高（6.0%比 3.8%，P<0.001）。与非衰弱组相比，衰弱患者的死亡率（2.2%比 0.5%，P<0.001）、术后卒中（2.6%比 1.0%，P<0.001）、MI（2.2%比 0.8%，P<0.001）和卒中和死亡（4.4%比 1.4%，P<0.001）的发生率更高。调整后，衰弱与死亡率（优势比[OR]1.59，95%置信区间：1.30-1.80，P<0.001）、卒中（OR 1.66，95%置信区间：1.38-1.83，P<0.001）、MI（OR 1.51，95%置信区间：1.29-1.72，P<0.001）和卒中和死亡（OR 1.62，95%置信区间：1.45-1.81，P<0.001）的风险增加相关。此外，衰弱与住院费用增加（β=+$5980，95%置信区间：$5490-$6470，P<0.001）和 LOS 延长（β=+2.6 天，95%置信区间：2.4-2.8，P<0.001）相关。
衰弱与颈动脉血运重建患者的不良结局和资源利用增加有关。风险模型应包括对衰弱的评估，以指导这些高危患者的管理并改善结局。
