Association of frailty with outcomes in patients with large vessel occlusion stroke undergoing mechanical thrombectomy.

Abstract

Purpose: Frailty is a clinical syndrome characterized by reduced physiological reserve and increased vulnerability to adverse health outcomes, potentially impacting patients undergoing mechanical thrombectomy for acute ischemic stroke due to large vessel occlusion (LVO). This study aimed to evaluate the influence of frailty on in-hospital outcomes in these high-risk patients.

Methods: We conducted a retrospective analysis of the National Inpatient Sample (2016-2021), identifying patients with large vessel occlusion stroke undergoing mechanical thrombectomy. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses. Propensity score matching (PSM) was applied to create balanced cohorts for primary analysis.

Results: In propensity-matched analysis, frail patients had higher in-hospital mortality (12.06% vs. 9.90%, P = 0.004), seizures (2.35% vs. 1.65%, P = 0.048), major adverse cardiac events (MACE) (15.29% vs. 13.51%, P = 0.044), pulmonary embolism (2.38% vs. 1.62%, P = 0.031), and hospital-acquired pneumonia (6.10% vs. 4.80%, P = 0.023). Sensitivity analysis using multivariable logistic regression confirmed similar trends, with frailty remaining an independent predictor of mortality (aOR 1.24, 95% CI: 1.04-2.23, P = 0.04).

Conclusion: Frailty is associated with significantly worse outcomes, including higher mortality, MACE, and pneumonia in patients undergoing mechanical thrombectomy for LVO. These findings emphasize the need for frailty screening as part of pre-procedural risk stratification and tailored management strategies to improve patient outcomes.