Transition in Frailty State Among Elderly Patients After Vascular Surgery
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ORIGINAL SCIENTIFIC REPORT
Transition in Frailty State Among Elderly Patients After Vascular Surgery Louise B. D. Banning1 • Linda Visser1 • Clark J. Zeebregts1 • Barbara L. van Leeuwen2 • Mostafa el Moumni3 • Robert A. Pol1
Ó The Author(s) 2020
Abstract Background Frailty in the vascular surgical ward is common and predicts poor surgical outcomes. The aim of this study was to analyze transitions in frailty state in elderly patients after vascular surgery and to evaluate influence of patient characteristics on this transition. Methods Between 2014 and 2018, 310 patients, C65 years and scheduled for elective vascular surgery, were included in this cohort study. Transition in frailty state between preoperative and follow-up measurement was determined using the Groningen Frailty Indicator (GFI), a validated tool to measure frailty in vascular surgery patients. Frailty is defined as a GFI score C4. Patient characteristics leading to a transition in frailty state were analyzed using multivariable Cox regression analysis. Results Mean age was 72.7 ± 5.2 years, and 74.5% were male. Mean follow-up time was 22.7 ± 9.5 months. At baseline measurement, 79 patients (25.5%) were considered frail. In total, 64 non-frail patients (20.6%) shifted to frail and 29 frail patients (9.4%) to non-frail. Frail patients with a high Charlson Comorbidity Index (HR = 0.329 (CI: 0.133–0.812), p = 0.016) and that underwent a major vascular intervention (HR = 0.365 (CI: 0.154–0.865), p = 0.022) had a significantly higher risk to remain frail after the intervention. Conclusions The results of this study, showing that after vascular surgery almost 21% of the non-frail patients become frail, may lead to a more effective shared decision-making process when considering treatment options, by providing more insight in the postoperative frailty course of patients.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00268-020-05619-7) contains supplementary material, which is available to authorized users. 3
& Louise B. D. Banning [email protected] 1
Department of Surgery, Division of Vascular Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
2
Department of Surgery, Division of Surgical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, Groningen, The Netherlands
Department of Surgery, Division of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, Groningen, The Netherlands
123
World J Surg
Introduction
Material and methods
Almost 40% of people aged 65 to 74 suffer from chronic diseases, and multi-morbidity is present in 60% of people older than 75 [1]. Multi-morbidity, defined as the coexistence of at least three chronic conditions, or chronological age do not seem to be the best methods to distinguish a physically frail patient from a fit patient [2]. Elderly people frequently cope with many cond
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