Frailty-based regression models strongly predicted 12-month mortality (AUC 0.81), prolonged LOS (AUC 0.79), and discharge to a care institution (AUC 0.84) in vascular surgery patients.
Cohort (n=413)
No
Does frailty predict mortality, prolonged length of stay, and readmission in vascular surgical patients aged over 65 years?
Frailty is a strong predictor of 12-month mortality, prolonged hospital stay, and discharge to a care institution in older vascular surgery patients.
Effect estimate: AUC 0.81 for 12-month mortality
BACKGROUND: Frailty is a multidimensional vulnerability resulting from age-associated decline. The impact of frailty on outcomes was assessed in a cohort of vascular surgical patients. METHODS: The study included patients aged over 65 years with length of hospital stay (LOS) greater than 2 days, who were admitted to a tertiary vascular unit over a single calendar year. Demographics, mode of admission, diagnosis, mortality, LOS and discharge destination were recorded, as well as a variety of frailty-specific characteristics. The impact of frailty on LOS, discharge destination, survival and readmission rate was assessed using multivariable regression techniques. The ability of the models to predict these outcomes was also assessed. RESULTS: In total, 413 patients of median age 77 years were followed for a median of 18 (range 12-24) months. The in-hospital, 3- and 12-month mortality rates were 3·6, 8·5 and 13·8 per cent respectively. Receiver operating characteristic (ROC) curve analysis revealed that frailty-based regression models were excellent predictors of 12-month mortality (area under the ROC curve (AUC) = 0·81), prolonged LOS (AUC = 0·79) and discharge to a care institution (AUC = 0·84). A simple additive frailty score using six key features retained strong predictive power for 12-month mortality (AUC = 0·83), discharge to a care institution (AUC = 0·78) and prolonged LOS (AUC = 0·74). This frailty score was also strongly associated with readmission rates (P < 0·001). CONCLUSION: Frailty in vascular surgery patients predicts a multiplicity of poorer outcomes. Optimal management should include identification of at-risk patients and treatment of modifiable risk factors.
Ambler et al. (Thu,) conducted a cohort in Vascular surgery (n=413). Frailty was evaluated on 12-month mortality, prolonged LOS, and discharge to a care institution (AUC 0.81 for 12-month mortality). Frailty-based regression models strongly predicted 12-month mortality (AUC 0.81), prolonged LOS (AUC 0.79), and discharge to a care institution (AUC 0.84) in vascular surgery patients.