Why the study?
Does preoperative frailty, assessed by the Barthel Index, predict mortality in patients with critical limb ischemia following infrainguinal bypass surgery?
Does preoperative frailty, assessed by the Barthel Index, predict mortality in patients with critical limb ischemia following infrainguinal bypass surgery?
Preoperative frailty, as measured by the Barthel Index, is an independent predictor of all-cause mortality in patients undergoing infrainguinal bypass for critical limb ischemia.
May inform preoperative risk stratification before infrainguinal bypass; leaves open whether frailty modification improves survival.
BACKGROUND: Most patients with critical limb ischemia (CLI) exhibit severe comorbidities accompanied by frailty. This study assessed and risk-stratified mortality after infrainguinal bypass (IB) in CLI and investigated the effects of frailty. METHODS AND BI (hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.94-0.99, P=0.004), BMI (HR 0.85; 95% CI 0.75-0.95, P=0.003), atrial fibrillation (AF; HR 5.31; 95% CI 2.12-13.30, P<0.001), and ejection fraction (EF; HR 0.94; 95% CI 0.91-0.98, P=0.003) were independent predictors of mortality. Patients were divided into 2 groups based on BI (BI >75, n=71; and BI <70, n=36). Survival after IB was significantly lower for the lower BI group (P<0.001, log-rank test). After propensity score matching, post-IB survival remained significantly lower in the lower BI group (P=0.02). CONCLUSIONS: BI, BMI, AF, and EF were independently associated with all-cause mortality after IB for CLI. BI and BMI may be useful in identifying and optimizing treatment for high-risk frail patients.
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Kodama et al. (2017) studied this question.
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