The prognostic value of simple frailty and malnutrition screening tools for determining surgical risk in patients with chronic limb threatening ischaemia undergoing major vascular surgery: A retrospective cross-sectional study

Palmer, Joanne; Pymer, Sean; Smith, George; Ingle, Lee; Harwood, Amy; Chetter, Ian

Abstract

Background: This study aims to explore the prognostic value of simple frailty and malnutrition tools for determining postoperative outcomes at 30 days and 1 year in patients with CLTI undergoing major surgery.
Methods: This was a single-centre retrospective observational cross-sectional study in a tertiary UK Vascular centre. We applied the Derby Frailty Index (DFI), the Acute Frailty Network Criteria (AFNC), the Prognostic Nutritional Index (PNI) and Geriatric Nutritional Risk Index (GNRI) to routinely collected clinical audit data recorded from a combination of medical and nursing notes, blood test results, and discharge letters.
Results: We included 73 patients who had undergone amputation (age 69 [57-77] years; 71% male; body mass index 27 [23-31] kg∙m-2) and 66 patients who had undergone bypass (age 73 [64-81] years; 70% male; BMI 26 [22-30] kg∙m-2). The 30-day mortality rate of a frail patient (DFI and AFNC respectively) was 21% (n=8/39) and 23% (n=6/26) compared to 7% (n=7/100) for non-frail patients. Frailty was associated with 30-day (DFI = Odds ratio [OR]: 3.4 [95% confidence intervals [CI] 1.2-10.2], P=0.027; AFNC = OR: 3.4 [95% CI 1.1-10.7], P=0.034) and one-year (DFI = OR: 7.95 [95% CI 3.4-18.6], P<0.001; AFNC = OR: 5.9 [95% CI 2.4-14.7], P<0.001) mortality. Frailty, according to the AFNC, was also associated with an increased risk of re-admission. Neither of the malnutrition screening tools were associated with 30-day or one-year mortality (p>0.05).
Conclusion: Our analysis confirms that both the DFI and AFNC tools identify patients with CLTI who are at the greatest risk of poor outcomes following major surgery. Frailty warrants further investigation and should be part of the consent and joint decision-making process in this patient population, to personalise care and minimise the risk of poorer outcomes.

Citation

Palmer, J., Pymer, S., Smith, G., Ingle, L., Harwood, A., & Chetter, I. (in press). The prognostic value of simple frailty and malnutrition screening tools for determining surgical risk in patients with chronic limb threatening ischaemia undergoing major vascular surgery: A retrospective cross-sectional study. Journal of Vascular Societies Great Britain and Ireland, https://doi.org/10.54522/jvsgbi.2024.124

• Journal Article Type: Article
• Acceptance Date: Apr 24, 2024
• Online Publication Date: May 22, 2024
• Deposit Date: May 3, 2024
• Journal: Journal of Vascular Societies Great Britain and Ireland
• Publisher: Vascular Society for Great Britain and Ireland
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.54522/jvsgbi.2024.124
• Keywords: Chronic limb-threatening ischaemia; Frailty; Malnutrition; Mortality; Postoperative complications
• Public URL: https://hull-repository.worktribe.com/output/4659925