Association of Age and Frailty with the Development of Adverse Events Following Carotid Endarterectomy in Asymptomatic Patients.

Background: As carotid endarterectomy (CEA) is increasingly utilized for older adults, identification of risk factors in this cohort is critical. Frailty is increasingly recognized as a significant predictor of adverse surgical outcomes, yet contemporary associations with CEA outcomes in asymptomatic patients remains underexplored on a national scale.

Methods: All adults (≥18) with asymptomatic carotid artery stenosis undergoing elective CEA were identified from the 2013-2022 National Surgical Quality Improvement Program Participant Use Files. Frailty was defined using the validated 5-factor modified frailty index (dependent functional status, diabetes, hypertension, chronic obstructive pulmonary disease, congestive heart failure), with patients scoring ≥2 classified as Frail (others: non-Frail). Multivariable logistic regression models examined associations of age and frailty status with major adverse events (MAE: death, stroke, or myocardial infarction) within 30 days, prolonged length of stay (≥2 postoperative days), non-home discharge, and unplanned readmission within 30 days.

Results: Of 18,887 CEA patients, 7,207 (38.2%) were Frail. Frail patients demonstrated increased MAE rates (3.5% vs. 1.9%, P<0.001) and greater resource use. After adjustment, frailty was linked with increased odds of MAE (AOR 1.60, 95% CI 1.29-1.98), prolonged length of stay (AOR 1.31, CI 1.21-1.41), non-home discharge (AOR 1.83, CI 1.40-2.39), and unplanned readmission (AOR 1.64, CI 1.41-1.92). Following marginal analysis of age and frailty, frailty remained associated with a higher risk-adjusted probability of major adverse events.

Conclusion: Irrespective of age, frail patients exhibited concerning rates of major adverse events. If future studies confirm these findings, prophylactic CEA in this vulnerable population should be carefully reconsidered.