TRANSITIONS OF FRAILTY AFTER LOWER EXTREMITY INTERVENTIONS FOR CHRONIC LIMB-THREATENING ISCHEMIA.

Abstract

Background: Frailty is common among surgical patients and predicts poor surgical outcomes. This study aimed to analyze transitions in frailty state among patients undergoing lower extremity care for chronic limb-threatening ischemia (CLTI).

Methods: Between 2018 and 2022, all patients undergoing a primary intervention for CLTI) (endovascular intervention-EV, bypass BYP, major amputation-AMP) or Wound Care (WOUND) were analyzed. Frailty was assessed by VQI-derived Risk Analysis Index (VQI-RAI). Frailty was defined as a VQI-RAI score > 35. Transition in frailty state between preoperative and follow-up measurement at one month and one year were analyzed. Patient characteristics leading to a transition in frailty state were analyzed using multivariable Cox regression analysis. Amputation-free survival (AFS; survival without major amputation) and freedom from major adverse limb events (MALE; Above ankle amputation of the index limb or major re-intervention (new bypass graft, jump/interposition graft revision) were evaluated.

Results: 1859 patients (56% male, age 65±11years, mean ± SD) underwent either EV (52%), a BYP (29%), AMP (13%), or WOUND (6%). 25% were considered frail on initial evaluation (28%, 16%, 32%, and 30% EV, BYP, AMP, and WOUND, respectively). At 30 days, overall frailty increased to 34%: 13% of patients moved from Non-Frail to Frail (9%, 18%, 22%, and 5% for EV, BYP, AMP, and WOUND, respectively), and 4% of patients moved from Frail to Non-Frail (6%, 2%, 1%, and 0% for EV, BYP, AMP, and WOUND, respectively). At one year, overall frailty increased to 40%: an additional 13% of patients shifted from Non-Frail to Frail (15%, 6%, 23%, and 8% for EV, BYP, AMP, and WOUND, respectively), and 5% of patients shifted from Frail to Non-Frail (4%, 8%, 2% and 0% for EV, BYP, AMP, and WOUND, respectively). At one year, frailty increased by 28% in EV, 16% for BYP, 32% in AMP, and 43% in WOUND. Frailty at baseline, 30 days, and one year was associated with a high Charlson's Comorbidity Index. Shifting to a frail state postoperatively was associated with decreased survival and a lower amputation-free survival at one year.

Conclusions: Following major interventions for CLTI at one year, 27% of patients shift from a Non-Frail to a Frail state, and 9% of patients shift from a Frail to a Non-Frail state with differences across modalities in comparison to WOUND, where 13% of patients moved from a Non-Frail to a Frail state, and none shifted from a Frail to a Non-Frail state Shifting to a frail state after intervention is associated with poor outcomes and should be considered when evaluating and intervention in a patient with CLTI.