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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 Sayers
Objective
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 266-276

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular Sciences

Version

  • AM (Accepted Manuscript)

Published in

Annals of Surgery

Volume

272

Issue

2

Pagination

266-276

Publisher

Lippincott, Williams & Wilkins, American Surgical Association, European Surgical Association

issn

0003-4932

Acceptance date

2019-08-31

Copyright date

2019

Available date

2021-08-01

Notes

The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.

Language

en

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