Impact of Frailty on Clinical Outcomes after Carotid Artery Revascularization

Ava D. Mandelbaum, Joseph Hadaya, Jesus G. Ulloa, Rhusheet Patel, John C. McCallum, Christian De Virgilio, Peyman Benharash

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Frailty has been increasingly recognized as an important risk factor for vascular procedures. To assess the impact of frailty on clinical outcomes and resource utilization in patients undergoing carotid revascularization using a national cohort. Methods: The 2005-2017 National Inpatient Sample was used to identify patients who underwent carotid endarterectomy (CEA) or carotid stenting (CAS). Patients were classified as frail using diagnosis codes defined by the Johns Hopkins Adjusted Clinical Groups frailty indicator. Multivariable regression was used to evaluate associations between frailty and in-hospital mortality, postoperative stroke, myocardial infarction (MI), hospitalization costs, and length of stay (LOS). Results: Of 1,426,343 patients undergoing carotid revascularization, 59,158 (4.2%) were identified as frail. Among frail patients, 79.4% underwent CEA and 20.6% underwent CAS. Compared to CEA, a greater proportion of patients undergoing CAS were frail (6.0% vs. 3.8%, P < 0.001). Compared to the nonfrail cohort, frail patients had higher rates of mortality (2.2% vs. 0.5%, P < 0.001), postoperative stroke (2.6% vs. 1.0%, P < 0.001), MI (2.2% vs. 0.8%, P < 0.001), and stroke/death (4.4% vs. 1.4%, P < 0.001). After adjustment, frailty was associated with increased odds of mortality (AOR = 1.59, 95% CI: 1.30-1.80, P < 0.001), stroke (AOR = 1.66, 95% CI: 1.38–1.83 P < 0.001), MI (AOR = 1.51, 95% CI: 1.29–1.72, P < 0.001), and stroke/death (AOR = 1.62, 95% CI: 1.45–1.81, P < 0.001). Furthermore, frailty was associated with increased hospitalization costs (β = +$5,980, 95% CI: $5,490–$6,470, P < 0.001) and LOS (β = +2.6 days, 95% CI: 2.4–2.8, P < 0.001). Conclusions: Frailty is associated with adverse outcomes and greater resource use for those undergoing carotid revascularization. Risk models should include an assessment of frailty to guide management and improve outcomes for these high-risk patients.

Original languageEnglish (US)
Pages (from-to)111-121
Number of pages11
JournalAnnals of Vascular Surgery
StatePublished - Jul 2021
Externally publishedYes


  • Carotid artery
  • Carotid artery stenosis
  • Carotid artery stenting
  • Carotid endarterectomy
  • NIS
  • National inpatient sample

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine


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