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Modified Frailty Index As An Indicator For Outcomes After Lower Extremity Endovascular Revascularization (LEER)
Naveen Balasundaram, *Shubham Kanake, *Vishruth Thagahalli Sunil Kumar, *Isaiah Chandra, *Riley D Burgon, *TODD R VOGEL
University of Missouri, Columbia, MO

OBJECTIVE(S): The 5- factor frailty index (mFI-5) is a standardized score that has been used as a reliable tool in predicting outcomes after surgery. The purpose of this study was to evaluate the performance of the mFI-5 after Lower extremity endovascular revascularization (LEER).
METHODS: The American College of Surgeonsí National Surgical Quality Improvement Program Database (NSQIP) was retrospectively analyzed for patients undergoing LEER between 2015 and 2019. Outcomes were assessed using univariate analysis (Mann Whitney, chi-square and Cochran Armitage test) and multivariate logistic regression analysis.
RESULTS: 12426 LEER performed between 2015 and 2019 were identified from the NSQIP database. Mean age was 69 (SD 11.39) years, 4,891 (39.4%) were female and 7,693 (64.1%) were white. 7840 (63.1%) were performed for chronic limb threatening ischemia (CLTI). 30-day mortality was 1.8%. Univariate analysis demonstrated that a mFI-5 score greater than 0.6 was associated with higher rates of prolonged hospital stay more than 7 days (24.7% vs 10.3%, p<0.0001, reference mFI-5=0), readmission (20.9% vs 11.0%, p<0.0001), reoperation, (14.1% vs 7.8%, p<0.0001), MI (2.8% vs 1.0%, p<0.0001), reintubation (2.8% vs 0.3%, p<0.0001), 30-day mortality (5.1 % vs 0.8%, p<0.0001). Beta blocker use, higher age, CLTI indication for surgery, and mFI-5 were all associated with increased 30-day mortality, while anatomical high risk was associated with decreased mortality, suggesting patient selection. Multivariate logistic regression (table 1) showed that mFI-5 remained as a significant predictor with mFI-5>0.6 predicting a 3 times higher odds for 30-day mortality (Odds ratio OR 3.057, p = 0.004), with Physiological high risk (OR 3.329, p<0.001), CLTI Indication (OR 2.648, p<0.001) and non elective procedures (OR 2.516, p<0.001) also showing increased risk for mortality
CONCLUSIONS: For patients undergoing LEE, higher mFI-5 was associated with increased hospital utilization, 30-day mortality, and 30-day readmission. The mFI-5, an easily calculated tool, may assist to identify patients at high risk for inferior outcomes. The mFI-5 may be useful for preoperative risk stratification and predicting mortality, and 30-day readmission for patients undergoing LEE

Multivariate analysis with effects of predictors on 30 day mortality
VariableOdds Ratiop - value
Age: (ref 18 - 59)60 - 691.6500.077
70 - 793.583<0.001
80+1.9830.013
mFI - 5: (ref 0)0.21.4340.355
0.41.6020.220
0.6 - 1.03.0570.004
Physiological High Risk3.329<0.001
Indication: Chronic Limb Threatening Ischemia (ref: asymptomatic/ claudication)2.648<0.001
C- statistic0.809


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