Outcome Analysis Using the Modified Frailty Index-5 in Patients With Complex Aortoiliac Disease

Frailty assessment tools in the emergency department: A geriatric emergency department guidelines 2.0 scoping review

Objective

Given the aging population and growing burden of frailty, we conducted this scoping review to describe the available literature regarding the use and impact of frailty assessment tools in the assessment and care of emergency department (ED) patients older than 60 years.

Methods

A search was made of the available literature using the Covidence system using various search terms. Inclusion criteria comprised peer-reviewed literature focusing on frailty screening tools used for a geriatric population (60+ years of age) presenting to EDs. An additional search of PubMed, EBSCO, and CINAHL for articles published in the last 5 years was conducted toward the end of the review process (January 2023) to search specifically for literature describing interventions for frailty, yielding additional articles for review. Exclusion criteria comprised articles focusing on an age category other than geriatric and care environments outside the emergency care setting.

Results

A total of 135 articles were screened for inclusion and 48 duplicates were removed. Of the 87 remaining articles, 20 were deemed irrelevant, leaving 67 articles for full-text review. Twenty-eight were excluded for not meeting inclusion criteria, leaving 39 full-text studies. Use of frailty screening tools were reported in the triage, care, and discharge decision-making phases of the ED care trajectory, with varying reports of usefulness for clinical decision-making.

Conclusion

The literature reports tools, scales, and instruments for identifying frailty in older patients at ED triage; multiple frailty scores or tools exist with varying levels of utilization. Interventions for frailty directed at the ED environment were scant. Further research is needed to determine the usefulness of frailty identification in the context of emergency care, the effects of care delivery interventions or educational initiatives for front-line medical professionals on patient-oriented outcomes, and to ensure these initiatives are acceptable for patients.

A systematic review of frailty assessment tools used in vascular surgery research

OBJECTIVE

Frailty is common in vascular patients and is recognized for its prognostic value. In the absence of consensus, a multitude of frailty assessment tools exist. This systematic review aimed to quantify the variety in these tools and describe their content and application to inform future research and clinical practice.

METHODS

Multiple cross-disciplinary electronic literature databases were searched from inception to August 2022. Studies describing frailty assessment in a vascular surgical population were eligible. Data extraction to a validated template included patient demographics, tool content, and analysis methods. A secondary systematic search for papers describing the psychometric properties of commonly used frailty tools was then performed.

RESULTS

Screening 5358 records identified 111 eligible studies, with an aggregate population of 5,418,236 patients. Forty-three differing frailty assessment tools were identified. One-third of these failed to assess frailty as a multidomain deficit and there was a reliance on assessing function and presence of comorbidity. Substantial methodological variability in data analysis and lack of methodological description was also identified. Published psychometric assessment was available for only 4 of the 10 most commonly used frailty tools. The Clinical Frailty Scale was the most studied and demonstrates good psychometric properties within a surgical population.

CONCLUSIONS

Substantial heterogeneity in frailty assessment is demonstrated, precluding meaningful comparisons of services and data pooling. A uniform approach to assessment is required to guide future frailty research. Based on the literature, we make the following recommendations: frailty should be considered a continuous construct and the reporting of frailty tools' application needs standardized. In the absence of consensus, the Clinical Frailty Scale is a validated tool with good psychometric properties that demonstrates usefulness in vascular surgery.

A retrospective study on the relationship between 5 modified frailty index (5-mFI) and postoperative complications of gynecological elderly patients undergoing abdominal surgery

INTRODUCTION

Aim to evaluate the application of 5 modified frailty index (5-mFI) in predicting postoperative complications in elderly gynecological patients undergoing abdominal surgery.

METHODS

A total of 294 elderly gynecological patients who were hospitalized in the affiliated Hospital of North Sichuan Medical College and underwent abdominal surgery from November 2019 to May 2022 were collected from the Union Digital Medical Record (UniDMR) Browser of the hospital. According to whether postoperative complications (infection, hypokalemia, hypoproteinemia, poor wound healing and intestinal obstruction) occurred, the patients were divided into complication group (n = 98) and non-complication group (n = 196). Univariate and multivariate logistic regression analysis were used to analyze the risk factors of complications in elderly gynecological patients undergoing abdominal surgery. The receiver operating characteristic (ROC) curve was used to determine the predictive value of the frailty index score in elderly gynecological patients with postoperative complications after abdominal surgery.

RESULTS

Postoperative complications occurred in 98 of 294 elderly gynecological patients undergoing abdominal surgery, accounting for 33.3%, 5-mFI (OR1.63, 95%CI 1.07-2.46,P = 0.022), age (OR1.08,95%CI 1.02-1.15, P = 0.009), operation time (OR 1.01, 95%CI 1.00-1.01). P < 0.001) were independent risk factors for postoperative complications in elderly patients undergoing abdominal surgery, and the area under the curve of postoperative complications in elderly gynecological patients was 0.60. (95%CI: 0.53-0.67, P = 0.005) CONCLUSION: Five modified frailty index can effectively predict the occurrence of postoperative complications in elderly gynecological patients.

Frailty Index (mFI-5) Predicts Resource Utilization after Nonruptured Endovascular Aneurysm Repair

INTRODUCTION

The 5- factor frailty index (mFI-5) has reliably predicted outcomes after vascular surgeries. The purpose of this study was to determine the performance of this index in aortic endovascular surgery ( endovascular aneurysm repair [EVAR]) MATERIALS AND METHODS: The American College of Surgeons' National Surgical Quality Improvement Program Database (NSQIP) was retrospectively analyzed for patients undergoing nonruptured EVAR between 2015 and 2019. Outcomes were assessed using bivariate analysis (Mann Whitney U test, chi-squared test, and t-test) and multivariate logistic regression analysis.

RESULTS

10,450 patients were identified with a mean age of 73.59 (SD 8.93) y. 8222 (78.7%) were performed for large diameter with the remaining indications including dissection, symptomatic, and embolization/thrombosis. 30-d mortality was 1.3%. Univariate analysis showed that mFI-5≥0.6 was associated with higher rates of prolonged hospital stay (18.8% versus 5.7%, P < 0.001, reference mFI-5 = 0), readmission (12.3% versus 5.9%, P < 0.001), mortality (3.6 % versus 1.2%, P = 0.01), intensive care unit (ICU) length of stay more than 3 d (7.2% versus 2.7%, P < 0.001). Female gender higher age, indication for surgery, and mFI-5 were all associated with increased mortality. Multivariate logistic regression showed that mFI-5 remained as a significant predictor with mFI-5≥0.6 predicting a close to 3 times higher odds for 30-d mortality (odds ratio OR 2.83, P = 0.003), ICU length of stay >3 d (OR 2.48, P < 0.001), >7 d hospital stay (OR 3.94, P < 0.001), readmission (OR 2.16, P < 0.001), and pneumonia (OR 4.2, P < 0.001) CONCLUSIONS: The modified frailty index (mFI-5) is a good predictor for postoperative complications and hospital resource utilization after nonruptured EVAR.

Modified frailty index as an indicator for outcomes after lower extremity endovascular revascularization

BACKGROUND

The 5-factor frailty index is associated with adverse outcomes after various procedures. This study aimed to evaluate the performance of the 5-factor frailty index after lower extremity endovascular revascularization.

METHODS

The American College of Surgeons' National Surgical Quality Improvement Program Database as retrospectively analyzed for patients undergoing lower extremity endovascular revascularization between 2015 and 2019. Outcomes were assessed using bivariate analyses and multivariate logistic regression analyses.

RESULTS

In the study, 11,947 lower extremity endovascular revascularization performed between 2015 and 2019 were identified from National Surgical Quality Improvement Program Database. Median age was 69 (standard deviation 11.44) years, 4,727 (39.6%) were female, and 7,570 (63.4%) were White. In addition, 7,541 (62.9%) were performed for chronic limb threatening ischemia. Thirty-day mortality was 1.7%. Bivariate analysis demonstrated that a 5-factor frailty index score greater than 0.6 was associated with higher rates of discharge to SNF (28.6% vs 8.2%, P < .001, reference 5-factor frailty index = 0), cardiopulmonary arrest (2.0% vs 0.1%, P < .001), readmission (21.1% vs 10.8%, P < .001), reintubation (2.8% vs 0.3%, P < .001), and 30-day mortality (5.1% vs 0.7%, P < .001). Beta blocker use, higher age, chronic limb threatening ischemia indication, and 5-factor frailty index were all associated with increased 30-day mortality. Multivariate logistic regression showed that 5-factor frailty index >0.6 predicted 3 times higher odds for 30-day mortality (odds ratio, 2.988; P = .013), with physiologic high risk (odds ratio, 2.118; P < .001), chronic limb threatening ischemia indication (odds ratio, 2.157; P < .001), and inpatient procedures (odds ratio, 3.409; P < .001) also showing increased risk for mortality.

CONCLUSION

For patients undergoing lower extremity endovascular revascularization, higher 5-factor frailty index was associated with increased hospital resource utilization and 30-day mortality. The 5-factor frailty index may be useful for preoperative risk stratification and predicting adverse outcomes in patients undergoing lower extremity endovascular revascularization.

The predictive value of triglyceride-glucose index for in-hospital and one-year mortality in elderly non-diabetic patients with ST-segment elevation myocardial infarction

BACKGROUND

Triglyceride-glucose (TyG) index, a reliable marker of insulin resistance, was associated with cardiovascular morbidity and mortality. This study aimed to evaluate the predictive value of TyG index for mortality in elderly non-diabetic patients with ST-segment elevation myocardial infarction (STEMI).

METHODS

In total, 430 non-diabetic patients aged over 65 years with STEMI were consecutively included. The TyG index was calculated by using the following formula: TyG index = ln (fasting triglyceride × fasting glucose/2). The 5-item modified frailty index score was utilized to determine comorbidities. Patients were divided into three groups based on TyG index tertiles.

RESULTS

Patients included into high TyG index tertile were male and had higher body mass index, glucose, triglyceride, low-density lipoprotein cholesterol, 5-item modified frailty index and GRACE risk score; and had low systolic blood pressure, estimated glomerular filtration rate and left ventricular ejection fraction. A one-unit increase in TyG index was associated with 3.03 extra cases per 1000 person-day for in-hospital mortality and 0.29 extra cases per 1000 person-day for long-term mortality. There was a non-linear relationship between TyG index and the risk of mortality with an increased risk above 8.5 for TyG index. Kaplan-Meier survival curves revealed that patients in high TyG index tertile had higher in-hospital and long-term mortality rates than those in low TyG index tertile.

CONCLUSIONS

This was the first study to demonstrate that the TyG index could predict in-hospital and long-term mortality in elderly non-diabetic STEMI patients.