Association of frailty with outcomes of endovascular thoracic and abdominal aneurysm repairs

BACKGROUND: Given the increasing use of endovascular repair of aortic aneurysms in elderly patients, accurate identification of patients with frailty is crucial for optimizing patient selection and care. The present study represents the first application of the recently developed Hospital Frailty Risk Score and its comparison with commonly used surgical frailty indices to investigate the association between frailty and outcomes after endovascular abdominal repair and thoracic endovascular aortic repair using a nationally representative database. METHODS: Adults undergoing elective endovascular abdominal repair and thoracic endovascular aortic repair for unruptured aortic aneurysms were identified in the 2016-2021 Nationwide Readmission Database and grouped into non-Frail and Frail cohorts using the Hospital Frailty Risk Score, Administrative Risk Analysis Index, and Johns Hopkins Adjusted Clinical Groups instruments. Multivariable regression models and area under the receiver operating characteristic curve were used to assess and compare the associations between frailty, adverse outcomes, and resource use. RESULTS: Of an estimated 105,265 patients who underwent endovascular abdominal repair and 16,595 patients who underwent thoracic endovascular aortic repair, 10.1% and 23.4% were classified as frail by Hospital Frailty Risk Score, respectively. After multivariable adjustment, frailty identified by Hospital Frailty Risk Score was associated with increased odds of mortality and perioperative complications, including respiratory, renal, and thromboembolic events. The Hospital Frailty Risk Score demonstrated the greatest discriminatory power, sensitivity, and specificity in predicting outcomes, outperforming the models that included Administrative Risk Analysis Index and Johns Hopkins Adjusted Clinical Groups. CONCLUSION: The Hospital Frailty Risk Score appears to be a reliable frailty instrument for predicting adverse outcomes in vulnerable populations undergoing vascular procedures. Given the critical role of accurately identifying frailty to optimize postoperative care and resource allocation, selecting the most appropriate frailty instrument is essential.