VESS07 - A Multivariate Analysis of a Modified Frailty Index on Perioperative Morbidity and Mortality Following Non-Emergent Endovascular Aortic Aneurysm Repair

Objectives: Frailty has become an increasingly recognized perioperative risk stratification tool. While frailty has been strongly correlated with worsening surgical outcomes, the individual determinants of frailty have rarely been investigated in the setting of aortic disease. The aim of this study was to examine the determinants of an 11-factor modified frailty index (mFI-11) on mortality and postoperative complications in patients undergoing endovascular aortic aneurysm repair (EVAR).

Methods: Data from the National Surgical Quality Improvement Program (NSQIP) database was queried for all patients undergoing elective EVAR between 2005 and 2019. Univariate logistic regression was used to assess associations between mFI-11 variables and complications occurring within 30 days of surgery. Significant variables were then used for multivariate analysis. Variables included in mFI-11 scoring are diabetes, partially or totally dependent functional status, chronic obstructive pulmonary disease or pneumonia, congestive heart failure, previous angina or myocardial infarction, previous percutaneous coronary intervention or cardiac surgery, hypertension requiring medication, peripheral vascular disease, impaired sensorium, and previous transient ischemic attack or cerebrovascular accident. Overall complications included superficial surgical site infections (SSI), deep incisional SSI, deep vein thrombosis, readmission, reintervention, bleeding requiring transfusions, life-threatening complications, and mortality. Life-threatening complications included those classified as Clavien-Dindo grade IV (CDIV). Odds ratios (OR) were calculated using SPSS 29.

Results: A total of 52,214 patients were identified, resulting in a cohort that was 80.5% male with an average age of 73.3±7.5 years. Binary regression revealed a significant increase in overall 30-day complications (OR: 1.343, p< 0.001), life-threatening complications (OR: 1.483, p< 0.001), acute renal failure (OR: 1.381, p< 0.001), myocardial infarction (OR: 1.529, p< 0.001), reintervention (OR: 1.156, p< 0.001), 30-day mortality (OR: 1.477, p< 0.001), and 1-year mortality (OR: 1.488, p< 0.001) per 1-point increase in mFI-11 score (Fig). Multivariate analysis demonstrated that functional dependency was highly associated with increased odds of all outcomes except myocardial infarction, and impaired sensorium was highly associated with both 30-day and 1-year mortalities (Table).

Conclusions: The mFI-11 is a strong predictor for postoperative complications as well as mortality in patients undergoing elective EVAR. Measurement of frailty using the mFI-11 scoring should be considered in the preoperative assessment of patients being evaluated for EVAR, with particular attention to the risk/benefit of aortic repair in those with dependent functional status or impaired sensorium.