A. P. Johnson1, P. J. DiMuzio1, S. W. Cowan1, H. A. Pitt2 1Thomas Jefferson University,Philadelphia, PA, USA 2Temple University,Philadelpha, PA, USA
Introduction: The Frailty Index (FI), based on the theory of “accumulating deficits,” was introduced in the Canadian Study of Health and Aging. Subsequently, a modified Frailty Index (mFI) was developed with NSQIP data; however, in recent years some of the variables employed in the mFI have been retired. We recently developed and validated an updated NSQIP Frailty Index (NFI) in colorectal surgery patients. The aim of this analysis is to validate this updated NSQIP Frailty Index (NFI) in patients undergoing vascular surgery.
Methods: The 2011-14 ACS-NSQIP vascular Participant Use File (PUF) was utilized, which samples for carotid stenting and endarterectomy, abdominal aortic aneurysm repair, and aortoiliac and lower extremity revascularizations. The NFI is a weighted product score assigning 2 points each for dependent functional status, transfer from chronic care facility, recent CHF exacerbation, severe COPD, renal failure on hemodialysis, recent ascites, disseminated cancer, hypoalbuminemia and 4 points for ASA IV or V. A product of eight or more points differentiates frail and non-frail patients. Receiver operator characteristics (ROC) analysis was performed to determine predictability for death or serious morbidity (DSM) and chi-squared analysis was used to determine association with multiple post-operative occurrences.
Results: Of 41,839 vascular patients, 4,988 (11.8%) were identified as frail per the NFI. The NFI demonstrated good predictability for DSM for vascular procedures (c-statistic = 0.69; CI 0.68-0.70). Frail patients were found to have higher rates of mortality (8.2 vs 1.2%), serious morbidity (18 vs 5.5%) and multiple other outcomes (Table, p<0.001).
Conclusion: An updated NSQIP Frailty Index (NFI) has been developed and validated in patients undergoing a cross section of vascular surgical procedures. The NFI can be a powerful tool to assist surgeons and patients in shared decision making and as an initial screening tool for more intensive frailty assessments and preoperative optimization.
