Department of Surgery, Audie Murphy VA Hospital, South Texas Veterans Healthcare System, San Antonio, TX; Department of Vascular and Endovascular Surgery, UT Health San Antonio, San Antonio, TX.
Department of Surgery, Audie Murphy VA Hospital, South Texas Veterans Healthcare System, San Antonio, TX; Department of Vascular and Endovascular Surgery, UT Health San Antonio, San Antonio, TX.
Ann Vasc Surg. 2022 Oct;86:295-304. doi: 10.1016/j.avsg.2022.04.007. Epub 2022 May 6.
Frailty assessments have been incorporated into preoperative planning for surgery in the elderly population. Frailty in patients undergoing lower extremity amputation has been associated with increased short-term mortality. We compared 2 frailty scores, modified Frailty Index (mFI) and Risk Analysis Index (RAI), to evaluate the short- and long-term mortality stratified by frailty status after lower extremity amputation.
A retrospective review at a single Veterans Affairs Medical Center was performed for all patients with peripheral vascular disease that underwent an above or below the knee amputation from 2014 to 2019. Preoperative variables were obtained to calculate the mFI and RAI frailty scores. The frailty scoring systems were used to separate the patients into 3 cohorts: non-frail (mFI <0.45, RAI <20), frail (mFI 0.45-0.55; RAI 20-32), and very frail (mFI >0.55, RAI >32). The frailty groups with each scoring system were compared for 30-day outcomes (readmission, reoperation, adverse events, length of stay) and short- and long-term mortality.
A total of 298 patients underwent lower extremity amputation. The number of non-frail patients was 98 (RAI) and 102 (mFI); frail patients 99 (RAI), and 123 (mFI); very frail patients 101 (RAI) and 73 (mFI). For the 30-day outcomes, only length of stay (mFI) was associated with increasing frailty. The short- and long-term mortality was associated with a worse survival with increasing frailty. At 1-year, the mortality by RAI was non-frail 8%; frail 24%, very frail 43% (P < 0.001); the mortality by mFI was non-frail 16%, frail 24%, very frail 41% (P < 0.001).
Preoperative frailty scoring systems identify patients with worse short- and long-term mortality for lower extremity amputation. Frailty scoring should be considered as a screening tool for patients with peripheral vascular disease undergoing lower extremity amputation because of the high rate of frail and very frail patients. The frailty status may provide a more patient-centered approach to counsel patients and their families on the risks and benefits of amputation.
虚弱评估已被纳入老年人群的手术术前规划中。下肢截肢患者的虚弱与短期死亡率增加有关。我们比较了两种虚弱评分，改良虚弱指数（mFI）和风险分析指数（RAI），以评估下肢截肢后按虚弱状态分层的短期和长期死亡率。
对 2014 年至 2019 年间在一家退伍军人事务医疗中心因外周血管疾病接受膝关节以上或以下截肢的所有患者进行了回顾性分析。获得术前变量以计算 mFI 和 RAI 虚弱评分。使用虚弱评分系统将患者分为 3 组：非虚弱（mFI<0.45，RAI<20）、虚弱（mFI0.45-0.55；RAI20-32）和非常虚弱（mFI>0.55，RAI>32）。比较每个评分系统的虚弱组在 30 天结局（再入院、再次手术、不良事件、住院时间）以及短期和长期死亡率方面的差异。
共有 298 例患者接受了下肢截肢。非虚弱患者的数量为 98 例（RAI）和 102 例（mFI）；虚弱患者 99 例（RAI）和 123 例（mFI）；非常虚弱患者 101 例（RAI）和 73 例（mFI）。在 30 天结局方面，只有住院时间（mFI）与虚弱程度增加有关。短期和长期死亡率与虚弱程度增加有关，生存率较差。在 1 年时，RAI 下的死亡率为非虚弱组 8%；虚弱组 24%，非常虚弱组 43%（P<0.001）；mFI 下的死亡率为非虚弱组 16%，虚弱组 24%，非常虚弱组 41%（P<0.001）。
术前虚弱评分系统可识别下肢截肢患者的短期和长期死亡率较高。由于虚弱和非常虚弱患者的比例较高，虚弱评分应作为接受下肢截肢的外周血管疾病患者的筛选工具。虚弱状态可以为患者及其家属提供更以患者为中心的方法来评估截肢的风险和获益。
