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Frailty factors and outcomes in vascular surgery patients: a systematic review and meta-analysis
journal contribution
posted 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 SayersObjective
To describe and critique tools used to assess frailty in vascular surgery patients, and
investigate its associations with patient factors and outcomes.
Background
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.
Conclusion
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.
Funding
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.
History
Citation
Annals of Surgery: August 2020 - Volume 272 - Issue 2 - p 266-276Author affiliation
/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular SciencesVersion
- AM (Accepted Manuscript)