TY - JOUR
T1 - Impact of Frailty on Clinical Outcomes after Carotid Artery Revascularization
AU - Mandelbaum, Ava D.
AU - Hadaya, Joseph
AU - Ulloa, Jesus G.
AU - Patel, Rhusheet
AU - McCallum, John C.
AU - De Virgilio, Christian
AU - Benharash, Peyman
N1 - Funding Information:
Sources of Funding: None.
Publisher Copyright:
© 2021
PY - 2021/7
Y1 - 2021/7
N2 - 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.
AB - 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.
KW - Carotid artery
KW - Carotid artery stenosis
KW - Carotid artery stenting
KW - Carotid endarterectomy
KW - NIS
KW - National inpatient sample
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U2 - 10.1016/j.avsg.2020.12.039
DO - 10.1016/j.avsg.2020.12.039
M3 - Article
C2 - 33556528
AN - SCOPUS:85101565931
SN - 0890-5096
VL - 74
SP - 111
EP - 121
JO - Annals of Vascular Surgery
JF - Annals of Vascular Surgery
ER -