Cuozzo Simone, Sbarigia Enrico, Jabbour Jihad, Marzano Antonio, D'Amico Carola, Brizzi Vincenzo, Martinelli Ombretta
Vascular Surgery Division, "Paride Stefanini" Department of Surgery, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy -
Vascular Surgery Division, "Paride Stefanini" Department of Surgery, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy.
J Cardiovasc Surg (Torino). 2024 Dec;65(6):515-522. doi: 10.23736/S0021-9509.24.13052-2. Epub 2024 Oct 23.
Frailty and it score assessment by the Clinical Frailty Scale (CFS) have been recently proposed in surgery to overcome chronological age and major comorbidities as predictor tools of the surgical risks. We aim to evaluate the impact of frailty on outcomes of patients undergoing TAAA endovascular repair and whether CFS may be used as screening tool in the preoperative work-up and peri-operative risk stratification.
REtrospective analysis of 76 patients (61 male, 74.9±6.9 years) undergoing elective branched-EVAR. Patients were divided in Group A (CFS<5) and Group B (CFS≥5). Post-operative morbidity, access-site related-complications, ICU- and in-hospital length-of-stay, reintervention rate, surgery- and all-causes related mortality were evaluated.
Fifty-four patients (71.1%) were classified as CFS<5, whereas twenty-two as CFS≥5. Demographics and comorbidities were homogeneous regardless of CFS class. No differences in term of MAE and of access-site related-complication but a greater perioperative and early mortality rate in the group of frail patients was noted (P=0.009, OR 11.8, 95% CI 1.35-3.58; P=0.019, respectively), as a longer hospitalization (P=0.007) and more frequent non-home discharge. Mid-term aneurysm- and all-causes related mortality was similar in both groups.
Frailty seems to be associated with worse perioperative outcomes. CFS is a reliable tool to quantify the degree of disability due to frailty and to better assess the risks and benefits of endovascular TAAA repair. Frailty is not equated with inoperability but indicate the need for a tailored approach for the more vulnerable patients. Larger studies and a widespread use of frailty screening methods are needed to confirm its efficacy in the prediction of outcomes after endovascular interventions.
最近外科领域提出了衰弱及其通过临床衰弱量表（CFS）进行评分评估，以克服按时间计算的年龄和主要合并症，作为手术风险的预测工具。我们旨在评估衰弱对接受胸主动脉瘤腔内修复术患者预后的影响，以及CFS是否可作为术前检查和围手术期风险分层的筛查工具。
对76例接受择期分支型腔内血管修复术的患者（61例男性，年龄74.9±6.9岁）进行回顾性分析。患者分为A组（CFS<5）和B组（CFS≥5）。评估术后发病率、穿刺部位相关并发症、重症监护病房和住院时间、再次干预率、手术及全因相关死亡率。
54例患者（71.1%）被分类为CFS<5，而22例为CFS≥5。无论CFS分级如何，人口统计学和合并症情况均相似。主要不良事件和穿刺部位相关并发症方面无差异，但衰弱患者组围手术期和早期死亡率更高（分别为P=0.009，OR 11.8，95%CI 1.35 - 3.58；P=0.019），住院时间更长（P=0.007），非回家出院更频繁。两组中期动脉瘤及全因相关死亡率相似。
衰弱似乎与更差的围手术期预后相关。CFS是一种可靠的工具，可量化因衰弱导致的残疾程度，并更好地评估胸主动脉瘤腔内修复术的风险和益处。衰弱并不等同于不可手术，但表明需要为更脆弱的患者采取量身定制的方法。需要更大规模的研究和广泛使用衰弱筛查方法来证实其在预测血管腔内干预后预后方面的有效性。
