N. Balasundaram1, A. Peters1, I. Chandra1, J. Bath1, T. R. Vogel1 1University Of Missouri, Columbia, MO, USA
Introduction: The 5- factor frailty index (mFI-5) is a standardized score that has been demonstrated as a reliable tool in predicting outcomes after surgery. The purpose of this study was to evaluate the performance of the mFI-5 as a predictor for hospital utilization, mortality, and readmission after Endovascular Aneurysm Repair (EVAR).
Methods: The American College of Surgeons’ National Surgical Quality Improvement Program Database (NSQIP) was retrospectively analyzed for patients undergoing elective EVAR between 2015 and 2019. Patients were divided into groups based on mFI-5 scores: mFI1 (0 – 0.19), mFI2 (0.2 – 0.39), mFI3 (0.4 – 0.59), and mFI4 (0.6-1). Outcomes were assessed using univariate analysis (Mann Whitney, chi-square, and t-test) and multivariate logistic regression analysis.
Results: 10,450 non-ruptured aneurysms were performed between 2015 and 2019 were identified from the NSQIP database. Mean age was 73.59 (SD 8.93) years, 2,068 (19.8%) were female and 7,690 (73.6%) were white. 8222 (78.7%) were performed for large diameter with the remaining indications including dissection, symptomatic and embolization/ thrombosis. 30-day mortality was 1.3%. 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 (18.8% vs 5.7%, p<0.005, reference mFI-5=0), readmission (12.3% vs 5.9%, p<0.005), 30-day mortality (3.6 % vs 1.2%, p = 0.01), and ICU length of stay more than 3 days (7.2% vs 2.7 p<0.005). Multivariate logistic regression (Table 1) demonstrated female gender, advanced age, indication for surgery, and mFI-5 were all associated with increased 30-day mortality. mFI-5 remained a significant predictor with mFI-5>0.6 having nearly 3 times higher odds for 30-day mortality (OR 2.83, p = 0.003)
Conclusions: For patients undergoing elective EVAR, a 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 mortality, hospital utilization, and 30-day readmission for patients undergoing elective EVAR and should be incorporated into preoperative risk stratification.
