Clinical Frailty Scale Predicts Outcomes After Elective Thoracic Endovascular Aortic Repair: A Single-Center Retrospective Cohort Study.

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Shingo Tsushima, Tsuyoshi Shibata, Yutaka Iba, Tomohiro Nakajima, Junji Nakazawa, Shuhei Miura, Ayaka Arihara, Keitaro Nakanishi, Takakimi Mizuno, Kei Mukawa, Nobuyoshi Kawaharada
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引用次数: 0

Abstract

Purpose: The Clinical Frailty Scale (CFS), used to define frail patients, is significantly associated with clinical outcomes. The CFS can predict postoperative prognosis after cardiovascular procedures. However, no reports exist on the relationship between frailty defined by the CFS and thoracic endovascular aortic repair (TEVAR) outcomes.

Materials and methods: We analyzed data obtained from patients who underwent TEVAR between January 2011 and December 2021. Frailty was assessed using the 9-point CFS and was defined as a score of ≥5 points. The primary outcome was the 5-year overall survival rate. The secondary outcomes included the rate of freedom from aneurysm-related death at 5 years, postoperative complications, length of stay, rate of nonhome discharge, need for mobility assistance, 30-day mortality rate, and re-intervention rate.

Results: Of 331 patients who underwent TEVAR, 186 were included. The mean age of frail (n=36) and nonfrail (n=150) patients was 73.2 ± 7.3 years and 70.9 ± 9.0 years, respectively (p=0.15). The length of stay (17 [9-39] vs 11 [10-16] days; p=0.09) and re-intervention rate (8.3% vs 13.3%; p=0.58) were not significantly different, although frail patients had a higher rate of nonhome discharge (33.3% vs 4.7%; p<0.001), need for mobility assistance (38.9% vs 6.0%; p<0.001), and 30-day mortality (11.1% vs 0.7%; p=0.005) than nonfrail patients. The 5-year overall survival rate after TEVAR was 6.2 ± 5.5 and 84.5 ± 3.4% in frail and nonfrail patients (p<0.001). The median survival time was 22 (6-40) and 136 (87-138&x41; months, the number of recorded deaths in 5 years was 28 (77.8%) and 18 (12.0%; p<0.001), and the rate of freedom from aneurysm-related death at 5 years was 80.7%±11.2% and 96.9%±1.5% (p=0.01) in frail and nonfrail patients, respectively. The mean follow-up time was 53.3 ± 2.7 months. Multivariate Cox regression indicated that the CFS (hazard ratio, 10.14; 95% confidence interval, 5.06-20.32) was significantly associated with overall survival.

Conclusion: The CFS is a valuable prognosis predictor, and TEVAR for frail patients with a high surgical risk could not improve the overall survival. Thoracic endovascular aortic repair in frail patients should be approached cautiously.

Clinical impact: The Clinical Frailty Scale (CFS) could be a useful predictor of prognosis in patients undergoing thoracic endovascular aortic repair (TEVAR). A significant difference was observed between frail and nonfrail patients in the 5-year overall survival rate following TEVAR. Thoracic endovascular aortic repair for frail patients (CFS was ≥5 points) could not improve overall survival because their death was attributed to their comorbidities. Thus, TEVAR in frail patients should be approached cautiously.

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来源期刊
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
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