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• W2947502253 abstract "Frailty is a clinical syndrome in which patients' ability to cope with physiologic stressors such as surgery is compromised. The Vascular Physiological and Operative Severity Score for enUmeration of Mortality (V-POSSUM) is a validated method for calculating levels of surgical stress associated with vascular procedures based on physiologic and operative variables. The objective of this study was to evaluate the relationship between frailty and development of adverse outcomes after vascular surgery procedures with different levels of surgical stress. We identified all independently living patients at a single academic institution between January 2016 and July 2018 who underwent prospective frailty assessment followed by an elective vascular surgery procedure captured in the Vascular Quality Initiative registry (endovascular aneurysm repair, thoracic endovascular aortic repair, suprainguinal and infrainguinal bypass, peripheral vascular intervention, carotid endarterectomy, open abdominal aortic aneurysm repair). Patient- and procedure-level clinical data were obtained from our institutional enterprise data warehouse and the Vascular Quality Initiative database and used to calculate V-POSSUM scores. The association between frailty and composite outcome of 30-day mortality or nonhome location at discharge after low-, moderate-, and high-stress vascular surgery procedures was evaluated using bivariate and logistic regression models. A total of 183 patients were identified (71% male; mean age, 68.3 years) who underwent open abdominal aortic aneurysm repair (6%), endovascular aneurysm repair (22%), thoracic endovascular aortic repair (8%), suprainguinal bypass (4%), infrainguinal bypass (17%), carotid endarterectomy (17%), or peripheral vascular interventions (25%), which included 52 (28%) patients diagnosed with frailty before surgery. Overall, frail patients had significantly higher rates of 30-day mortality or nonhome discharge (23% frail vs 8% nonfrail; P = .004) compared with nonfrail patients. When stratified by the degree of surgical stress, a dose-dependent effect was found, with significantly higher rates of 30-day mortality or nonhome discharge as the level of surgical stress increased in both frail and nonfrail patients (Fig). In regression models, frailty (odds ratio [OR], 2.7; 95% confidence interval, 1.0-7.0; P < .05) and high surgical stress (OR, 6.7; 95% confidence interval, 1.8-25.1; P < .01) were both found to be independent predictors of nonhome discharge or perioperative mortality. However, the interaction between these two variables was associated with the highest odds (OR, 17.4; P < .01) for experiencing this composite outcome. Frail patients experience significantly higher rates of nonhome discharge or perioperative mortality, particularly when undergoing high-stress vascular surgery procedures. V-POSSUM scores can be used in combination with preoperative frailty screening to better predict patient outcomes after vascular surgery." @default.
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• W2947502253 date "2019-06-01" @default.
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• W2947502253 title "IP245. Relationship Between Surgical Stress and Adverse Postoperative Outcomes Among Frail Vascular Surgery Patients: How Much Does It Take to Push Them Over the Edge?" @default.
• W2947502253 doi "https://doi.org/10.1016/j.jvs.2019.04.246" @default.
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