A Vascular Quality Initiative Frailty Assessment Predicts Post-Discharge Mortality in Patients Undergoing Arterial Reconstruction.
A Vascular Quality Initiative Frailty Assessment Predicts Post-Discharge Mortality in Patients Undergoing Arterial Reconstruction. Journal of vascular surgery 2022Abstract
INTRODUCTION: Frailty assessment adds important prognostic information during pre-operative decision-making but can be cumbersome to implement into routine clinical care. We developed and tested an abbreviated method of frailty assessment using variables routinely collected by the Vascular Quality Initiative (VQI) registry.METHODS: An abbreviated frailty score (VQI-FS) was developed using eleven or fewer VQI variables (hypertension, congestive heart failure, coronary artery disease, peripheral vascular disease, diabetes, COPD, renal impairment, anemia, underweight, non-home residence, non-ambulatory status) that map to recognized frailty domains in the Comprehensive Geriatric Assessment and the literature. Non-emergent cases registered in the VQI from 2010-2017 (n=265,632) in seven registries (CEA, N=77,111; CAS, N=13,215; EVAR, N=29,607; OAAA, N=7442; INFRA, N=33,128; SUPRA, N=10,661; PVI, N=94,468) were analyzed using logistic regression models to determine the predictive power of the VQI-FS for perioperative and longer-term (9-month) mortality. Nomograms were created using weighted regression coefficients to assist in individualized frailty assessment and estimation of 9-month mortality.RESULTS: The VQI-FS using equal weighting of eleven VQI variables effectively predicted 9-month mortality with an area under the curve (AUC) of 0.724 by receiver operating characteristic (ROC) curve analysis. However, differential weighting of the variables allowed simplification of the model to only seven variables (CHF, renal impairment, COPD, not living at home, not ambulatory, anemia, underweight status) as hypertension, coronary artery disease, peripheral vascular disease and diabetes had relatively low predictive power. Adding procedure-specific risk further improved performance of the model with a final AUC on ROC analysis of 0.758. Model calibration was excellent with predicted/observed regression line slope of 0.991 and intercept of 5.449e-04.CONCLUSIONS: A differentially weighted abbreviated VQI-FS using seven variables in addition to procedure-specific risk has strong correlation with 9-month mortality. Nomograms incorporating patient- and procedure-adjusted risk can effectively predict 9-month mortality. Reliable estimates of longer-term mortality should assist in pre-operative decision-making for vascular procedures that often carry substantial risk of mortality.
View details for DOI 10.1016/j.jvs.2022.05.017
View details for PubMedID 35709866