Lara Lopes, Calvin L Chao, Nicola Habash, Deena El-Gabri, Margaret Reilly, Veronica M Boratyn, Gabrielle Osher, Ashley K Vavra
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引用次数: 0
Abstract
Objective: The aim of this study was to evaluate the impact of frailty on enhanced recovery protocol (ERP) compliance and the impact of ERP on adverse postoperative outcomes in frail patients undergoing infra-inguinal arterial bypass (IB).
Methods: We performed a retrospective single-institution study of patients undergoing IB (2021-2024). Patients were categorized into three frailty groups using the NSQIP 5-item frailty index where F1=less frail (F1=0-1 risk factor; F2=2 risk factors; F3=3-5 risk factors). The association between frailty and both ERP compliance and postoperative outcomes were analyzed. Chi-square and Fisher's exact tests were used for categorical variables while continuous variables were analyzed by Kruskal-Wallis test. Time-to-event outcomes were assessed using Kaplan-Meier survival analysis in the elective intervention cohort, with follow-up truncated at 30 days.
Results: 257 patients were identified and stratified by frailty (F1=32.7%; F2=36.6%; F3=30.7%). F1 patients were significantly younger (mean age in years F1=65.0; F2=71.6; F3=71.6; p <0.001) and less likely to present with tissue loss (F1=31.0%; F2=47.9%; F3=62.0%; p<0.001). ERP compliance was not associated with frailty (F1=57.1%; F2=54.8%; F3=61.5%; p=0.739). Overall, patients who underwent ERP had a significantly shorter median postoperative LOS compared to non-ERP patients (4.8 vs. 7.0 days, p<0.001). Within the F3 cohort, ERP compliance was associated with lower reintervention rate (ERP=15.0% vs. non-ERP=33.3%; p=0.050); lower postoperative length of stay (ERP=7.9 days vs. non-ERP=9.8 days, p=0.016); and a reduction in 30-day mortality (ERP=2.5% vs. non-ERP=7.7%; p=0.298). In time-to-event analysis of elective procedures, no differences were observed in the 30-day freedom from reintervention, readmission or mortality.
Conclusion: High frailty was not a barrier to the implementation of ERP and ERP was associated with improved postoperative outcomes in highly frail patients.
期刊介绍：
Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.
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