Ali T, et al. – Authors planned this work to correlate the postoperative outcomes after lower extremity bypass surgery with pre operative modified frailty index. Findings demonstrated the utility of modified frailty index (mFI) as a valuable tool to identify patients at a higher risk for developing postoperative complications after lower extremity revascularization. There appeared a significant increase in the risk of mortality and complications for patients with mFI score of 0.54–0.63. mFI can be used as a useful screening tool to identify patients who are at a high risk for developing complications.

Methods

• Using 2010 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, authors identified patients undergoing infrainguinal arterial bypass surgery.
• They used mFI with 11 variables, based on the Canadian Study of Health and Aging Frailty Index.
• As per mFI score, they divided the patients into four groups: Group 1 (mFI score: 0-0.09), Group 2 (mFI score: 0.18-0.27), Group 3 (mFI score: 0.36-0.45), and Group 4 (mFI score: 0.54-0.63).
• Using logistic regression analysis, a bivariate and multivariate analysis was performed.

Results

• Authors identified 4,704 patients (64% Males, 36% Females) who underwent infrainguinal arterial bypass.
• Mean age was 67.9 ± 11.7 years.
• As per mFI, distribution of patients was as follows: Group 1: 14.6%, Group 2: 55.9%, Group 3: 26.9% and Group 4: 2.6%.
• Increase in mFI seemed associated with higher mortality rates.
• In this study, incidence of mortality for Group 1 was 0.6%, for Group 2, it was 1.4%, for Group 3, it was 4% and for Group 4, it was 7.4%.
• Likewise, significantly higher incidence of other postoperative complications such as myocardial infarction, stroke, progressive renal failure and graft failure was evident among patients with high mFI scores.
• Increased risk of mortality seemed associated with following factors: high mFI score, black race, dialysis dependency, post operative renal insufficiency, myocardial infarction and post operative acute renal failure.