Frailty factors and outcomes in vascular surgery patients: a systematic review and meta-analysis
journal contributionposted on 2019-09-02, 16:25 authored by J Houghton, A Nickinson, A Morton, S Nduwayo, C Pepper, H Rayt, L Gray, S Conroy, V Haunton, R Sayers
To describe and critique tools used to assess frailty in vascular surgery patients, and investigate its associations with patient factors and outcomes.
Increasing evidence shows negative impacts of frailty on outcomes in surgical patients, but little investigation of its associations with patient factors has been undertaken. Methods
Systematic review and meta-analysis of studies reporting frailty in vascular surgery patients (PROSPERO registration: CRD42018116253) searching Medline, Embase, CINAHL, PsycINFO and Scopus. Quality of studies was assessed using Newcastle Ottawa scores (NOS) and quality of evidence using GRADE criteria. Associations of frailty with patient factors were investigated by difference in means (MD) or expressed as risk ratios (RR), and associations with outcomes expressed as odds ratios (OR) or hazard ratios (HR). Data were pooled using random effects models. Results
Fifty-three studies were included in the review and only 8 (15%) were both good quality (NOS ≥7) and used a well-validated frailty measure. Eighteen studies (62,976 patients) provided data for the meta-analysis. Frailty was associated with increased age (MD 4.05 years; 95% confidence interval [CI] 3.35, 4.75), female sex (RR 1.32; 95%CI 1.14, 1.54), and lower body-mass index (MD -1.81; 95%CI -2.94, -0.68). Frailty was associated with 30-day mortality (adjusted [A]OR 2.77; 95%CI 2.01-3.81), post-operative complications (AOR 2.16; 95%CI 1.55, 3.02) and long-term mortality (HR 1.85; 95%CI 1.31, 2.62). Sarcopenia was not associated with any outcomes.
Frailty, but not sarcopenia, is associated with worse outcomes in vascular surgery patients. Well-validated frailty assessment tools should be preferred clinically, and in future research.
J. Houghton, A. Nickinson and S. Nduwayo are funded, and R. Sayers part-funded, by a charitable donation from the George Davies Charitable Trust (Registered Charity Number: 1024818) and supported by the NIHR Leicester Biomedical Research Centre. The authors would like to thank George Davies and the George Davies Charitable Trust for the generous charitable donation that funded this work, Tanya Payne for her support as the George Davies Research Group manager and Prof Matt Bown for his advice.
CitationAnnals of Surgery: August 2020 - Volume 272 - Issue 2 - p 266-276
Author affiliation/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular Sciences
- AM (Accepted Manuscript)