OBJECTIVE: Frailty has persistently been associated with unfavourable short-term outcomes after vascular surgery, such as increased complication risk, higher readmission rate and higher short-term mortality. However, a knowledge gap remains concerning the association between pre-operative frailty and long-term mortality. In this study, we aim to determine this association in elective vascular surgery patients.
METHODS: This study is part of a large prospective cohort study initiated in 2010 in our tertiary referral teaching hospital to study frailty in elderly elective vascular surgery patients (Vascular Ageing Study). In total, 639 patients with a minimal follow-up of five years, treated between 2010 and 2014, were included. The Groningen Frailty Indicator, a 15-item self-administered questionnaire, was used to determine the presence and degree of frailty.
RESULTS: In total, 183 patients (28.6%) were considered frail preoperatively. For frail patients, the actuarial survival after 1, 3 and 5 years was 81.4%, 66.7%, and 55.7%. For non-frail patients, these numbers were 93.6%, 83.3% and 75.2% respectively (log-rank test p<0.001). Frail patients had a significantly higher risk for 5-year mortality [unadjusted HR 2.09 (95% CI 1.572-2.771); p<0.001]. After adjusting for surgical and patient-related risk factors, the HR was 1.68 (95% CI 1.343-2.453; p=0.001).
CONCLUSION: This study shows that preoperative frailty is associated with a significantly increased long-term mortality after elective vascular surgery. The knowledge about a patients' preoperative frailty state could therefore be helpful in shared-decision making, since it provides more information about the procedural benefits and risks.