Association of Frailty Index and Outcomes After Acute Limb Ischemia Revascularization in the VQI

Frailty in patients undergoing surgery is strongly associated with postoperative complications. The risk analysis index (RAI) is a validated model for frailty that has been shown to predict short- and long-term outcomes. Through novel utilization of the Vascular Quality Initiative (VQI), this study examined the application of the RAI in acute limb ischemia (ALI) patients undergoing lower extremity revascularization. This is a longitudinal retrospective cohort study conducted on patients undergoing revascularization for ALI from the inception of the VQI database to the present. Using preoperative variables, an RAI score was calculated for each patient, and they were stratified into six cohorts based on their score: ≤20, 21-25, 26-30, 31-35, 35-40, and ≥41. The χ2 and analysis of variance tests were used to compare cohorts. A binary forward multivariate logistic regression was used to determine the risk in each cohort on postoperative outcomes (mortality, amputation, surgical site infection, bypass revision, patency, and discharge destination). The VQI dataset included 3620 patients (72.1% male) with an average age of 65 ± 12 years. The cohorts contained 20.2% (n = 778), 28.5% (n = 1030), 25.3% (n = 917), 13.5% (n = 490), 7.8% (n = 281), and 3.4% (n = 124) for RAI cohorts ≤20, 21-25, 26-30, 31-35, 36-40, and ≥41, respectively. After conducting a binary forward multivariate logistic regression, frailty was not associated with amputation, surgical site infection, or bypass revision. However, frailty at the highest vs lowest RAI score was significantly associated with 3.26 (95% confidence interval [CI], 1.92-5.49; P < .001) higher times the odds of mortality, 0.32 (95% CI, 0.21-0.48; P < .001) lower times the odds of being discharged home, and 1.72 (95% CI, 1.10-2.78; P < .021) higher times the odds of primary patency (Table). Our results confirm that the RAI is a valid screening tool for frailty, given how it demonstrated significant associations with mortality, discharge destination, and patency. Therefore, when revascularizing frail patients for ALI, the RAI can be an additional tool used to guide clinical decision making. Because this is the first time a long-term outcomes national database like the VQI was utilized on this topic, our research supports the incorporation of the RAI as a screening tool for patients with ALI undergoing revascularization.TableOdds ratios for significant outcomes after revascularization in patients with acute limb ischemia (ALI) stratified by risk analysis index (RAI)aVariable1-Year mortalityDischarged homePrimary patencyOR (95% CI)P valueOR (95% CI)P valueOR (95% CI)P valueRAI ≤20Ref 21-251.19 (0.83-1.72).3481.02 (0.80-1.29).91.15 (0.93-1.41).185 26-301.74 (1.23-2.49)≤.0010.64 (0.51-0.81)≤.0011.35 (1.09-1.67).008 31-352.18 (1.49-3.22)≤.0010.45 (0.35-0.59)≤.0011.30 (1.00-1.69).049 36-401.89 (1.20-2.96)≤.0010.39 (0.29-0.53)≤.0011.52 (1.10-2.08).012 ≥413.26 (1.92-5.49)≤.0010.32 (0.21-0.48)≤.0011.72 (1.10-2.78).021Race BlackRef White1.37 (0.99-1.92).0631.27 (1.02-1.57).0330.85 (0.68-1.06).150Smoking NeverRef Prior1.41 (1.02-1.97).0401.19 (0.95-1.49).1230.84 (0.67-1.05).136 Current1.34 (0.96-1.89).0900.99 (0.79-1.23).9130.91 (0.73-1.14).436Diabetes NoRef Yes1.32 (1.07-1.65).0110.76 (0.65-0.89)≤.0010.94 (0.80-1.10).446Hypertension NoRef Yes2.03 (1.37-3.15)≤.0011.00 (0.79-1.26).9841.10 (1.35-0.88).387Previous bypass NoRef Yes0.99 (0.80-1.24).9620.69 (0.59-0.81)≤.0010.56 (0.49-0.66)≤.001CI, Confidence interval; OR, odds ratio; Ref, reference.aORs were determined by forward binary logistic regression with covariates of race, smoking diabetes, hypertension, and previous bypass history. Open table in a new tab