The assessment of frailty and malnutrition in vascular surgery

The world is faced with an ageing population. Compared to other medical specialties, the inflow of elderly patients will have its highest impact in vascular surgery. In this ageing vascular patient population, it is crucial to select which patients will benefit the most of a vascular intervention in terms of quality of life and survival. Over the past decades, it became clear that biological age provides more information about a patients’ fitness than chronological age. One way of approaching biological ageing is by using the frailty syndrome to describe the most vulnerable elderly patients.The frailty syndrome contains several physical domains, for example visual impairment, hearing impairment, comorbidities, physical functioning and nutritional status. Both the roles of frailty and malnutrition in vascular surgery patients are investigated in this thesis. We found that 24% of the patients were at medium to high risk for malnutrition and that these patients are more prone to develop postoperative complications. Secondly, we found that preoperative frailty leads to more postoperative complications and a worse 5-year survival. Moreover, frailty is dynamic in vascular surgery patients and is affected by the surgical intervention. These results wil hopefully lead to a better estimation of postoperative outcomes in terms of complications and functioning. The growing share of elderly patients in the vascular clinic demands an adapted, multidisciplinary approach.