Comparative analysis of frailty indices in predicting outcomes after aortic aneurysm repair

Objective Frailty is increasingly recognized as a key driver of postoperative risk in vascular surgery, yet the comparative accuracy of major frailty indices in patients undergoing aortic surgery remains unclear. We compared the predictive accuracy of the Modified Frailty Index, Risk Analysis Index, Vascular Quality Initiative Frailty Index, and Vascular Quality Initiative Procedure-Based Index in predicting adverse postoperative outcomes in patients undergoing open and endovascular aortic aneurysm repair. Methods In this retrospective single-center cohort study, 131 patients who underwent open or endovascular aortic aneurysm repair between January 1 and December 31, 2023, were included. Frailty scores were calculated retrospectively based on data available at the time of preoperative evaluation. Primary outcomes were 30-day and 60-day hospital readmissions, in-hospital mortality, and 1-year mortality. Secondary outcomes included 30-day stroke, acute kidney injury, myocardial infarction, and reintervention. Statistical associations were evaluated using logistic regression models. Results The cohort's mean age was 70.6 ± 9 years, 31% were female, and pathology included abdominal aortic aneurysm (70%), thoracic aortic aneurysm (11%), thoracoabdominal aortic aneurysm (13%), and aortic dissection (6%). Interventions included endovascular aneurysm repair (34%), thoracic endovascular aortic repair (19%), fenestrated endovascular aortic repair (16%), and open repair (31%). Thirty-day readmission was the only outcome significantly associated with frailty across multiple indices. In the combined, open and endovascular, cohort, the Modified Frailty Index (odds ratio, 2.15; 95% confidence interval, 1.28-3.78; P=.01; area under the curve, 0.71), Risk Analysis Index (odds ratio, 1.09; 95% confidence interval, 1.01-1.18; P=.02; area under the curve, 0.72), and Vascular Quality Initiative Frailty Index (odds ratio, 1.74; 95% confidence interval, 1.25-2.52; P=.002; area under the curve, 0.73) demonstrated significant associations with 30-day readmission. Conclusions In patients undergoing aortic aneurysm repair, frailty indices demonstrated limited predictive value across most postoperative outcomes. Thirty-day readmission was the only outcome consistently associated with frailty scores, with no significant performance differences among the four indices tested. The vascular-specific indices did not outperform generic measures in this cohort, highlighting the need for aortic-specific risk stratification tools.