Gender and frailty predict poor outcomes in infrainguinal vascular surgery

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• 作者：Reshma Brahmbhatt ; MD^a ; Luke P. Brewster ; MD ; PhD^a ; ^b ; Susan Shafii ; MD^a ; Ravi R. Rajani ; MD^a ; Ravi Veeraswamy ; MD^a ; Atef Salam ; MD^a ; ^b ; Thomas F. Dodson ; MD^a ; Shipra Arya ; MD ; SM^a ; ^b ; ^{shipra.arya@emory.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Infrainguinal bypass ; Frailty ; Gender ; Complications ; Outcomes ; Revascularization
• 刊名：Journal of Surgical Research
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：201
• 期：1
• 页码：156-165
• 全文大小：687 K

文摘

Women have poorer outcomes after vascular surgery as compared to men as shown by studies recently. Frailty is also an independent risk factor for postoperative morbidity and mortality. This study examines the interplay of gender and frailty on outcomes after infrainguinal vascular procedures.

Materials and methods

The American College of Surgeons National Surgical Quality Improvement Program database was used to identify all patients who underwent infrainguinal vascular procedures from 2005–2012. Frailty was measured using a modified frailty index (mFI; derived from the Canadian Study of Health and Aging). Univariate and multivariate analysis were performed to investigate the association of preoperative frailty and gender, on postoperative outcomes.

Results

Of 24,645 patients (92% open, 8% endovascular), there were 533 deaths (2.2%) and 6198 (25.1%) major complications within 30 d postoperatively. Women were more frail (mean mFI = 0.269) than men (mean mFI = 0.259; P < 0.001). Women and frail patients (mFI>0.25) were more likely to have a major morbidity (P < 0.001) or mortality (P < 0.001) with the highest risk in frail women. On multivariate logistic regression analysis, female gender and increasing mFI were independently significantly associated with mortality (P < 0.05) as well as major complications. The interaction of gender and frailty in multivariate analysis showed the highest adjusted 30-d mortality and morbidity in frail females at 2.8% and 30.1%, respectively and that was significantly higher (P < 0.001) than nonfrail males, nonfrail females and frail males.

Conclusions

Female gender and frailty are both associated with increased risk of complications and death following infrainguinal vascular procedures with the highest risk in frail females. Further studies are needed to explore the mechanisms of interaction of gender and frailty and its effect on long-term outcomes for peripheral vascular disease.