A Multivariate Analysis of a Modified Frailty Index on Perioperative Morbidity and Mortality Following Nonemergent Endovascular Aortic Aneurysm Repair

Frailty has become an increasingly recognized perioperative risk stratification tool. Although 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). Data from the National Surgical Quality Improvement Program database were queried for all patients who underwent 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, deep incisional surgical site infections, deep vein thrombosis, readmission, reintervention, bleeding requiring transfusions, life-threatening complications, and mortality. Life-threatening complications included those classified as Clavien-Dindo grade IV. Odds ratios (OR) were calculated using SPSS 29. 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 < .001), life-threatening complications (OR: 1.483, P < .001), acute renal failure (OR: 1.381, P < .001), myocardial infarction (OR: 1.529, P < .001), reintervention (OR: 1.156, P < .001), 30-day mortality (OR: 1.477, P < .001), and 1-year mortality (OR: 1.488, P < .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). mFI-11 is a strong predictor for postoperative complications and mortality in patients undergoing elective EVAR. The 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.TableMultivariate analysis of 11-factor modified frailty index (mFI-11) variables and rates of complications after endovascular aortic aneurysm repair (EVAR)Overall complications (N = 40,280)CDIV (N = 52,214)Acute renal failure (N = 52,214)Myocardial infarction (N = 52,214)Reintervention (N = 52,214)30-day mortality (N = 52,214)1-year mortality (N = 52,214)OR (95% CI)POR (95% CI)POR (95% CI)POR (95% CI)POR (95% CI)POR (95% CI)POR (95% CI)PDiabetes1.01 (0.86, 1.19)896––––––––––––Hypertension1.20 (1.02, 1.40)0231.83 (11.40, 2.38)<0011.63 (1.00, 2.65)0483.01 (1.58, 5.75)<0011.16 (0.96, 1.42)1331.76 (1.16, 2.67)0071.67 (1.13, 2.48)010Functional dependency4.29 (3.07, 5.99)<0012.67 (2.01, 3.55)<0012.93 (1.78, 4.80)<0011.59 (0.84, 3.01)1562.12 (1.60, 2.80)<0014.33 (2.97, 6.30)<.0014.21 (2.92, 6.08)<.001COPD or pneumonia1.332 (1.149, 1.545)<.0011.48 (1.22, 1.79)<.0011.26 (0.87, 1.82).2201.46 (1.00, 2.12).0481.21 (1.01, 1.45).0371.64 (1.23, 2.20)<.0011.66 (1.25, 2.20)<.001Congestive heart failure1.913 (1.15, 3.19).0131.90 (1.20, 2.99).0061.87 (0.83, 4.19).1301.49 (0.59, 3.79).4031.52 (0.94, 2.46).0861.41 (0.69, 2.91).3481.29 (0.63, 2.66).488Myocardial infarction1.71 (0.92, 3.21)0.0921.42 (0.76, 2.63).269––2.31 (0.92, 5.81).075––––––Previous heart procedures or angina1.34 (1.18, 1.52)<.0011.28 (1.07, 1.51).0061.31 (0.95, 1.81).0961.74 (1.25, 2.43).001––1.21 (0.92, 1.59).1651.28 (0.99, 1.67).061Peripheral vascular disease1.53 (1.22, 1.91)<.0011.79 (1.38, 2.31)<.0012.33 (1.51, 3.60)<.0011.65 (1.00, 2.72).0521.79 (1.42, 2.27)<.0011.37 (0.89, 2.12).1571.33 (0.87, 2.05).187TIA or stroke1.18 (0.97, 1.44).0911.20 (0.94, 1.54).238––––––––––Impaired sensorium1.42 (0.42, 4.78).5851.82 (0.67, 4.93).238––––––4.12 (1.51, 11.25).0064.99 (1.96, 12.71)<.001CI, Confidence interval; CDIV, Clavien-Dindo grade IV; COPD, chronic obstructive pulmonary disease; OR, odds ratio; TIA, transient ischemic attack.Only variables that were significant on univariate analysis were included in multivariate analysis.Boldface P values represent statistical significance. Open table in a new tab