Preoperative frailty Risk Analysis Index to stratify patients undergoing carotid endarterectomy

J Vasc Surg. 2015 Mar;61(3):683-9. doi: 10.1016/j.jvs.2014.10.009. Epub 2014 Dec 9.

Abstract

Objective: Rapid and objective preoperative assessment of patients undergoing carotid endarterectomy (CEA) remains problematic. Preoperative variables correlate with increased morbidity and mortality, yet no easily implemented tool exists to stratify patients. We determined the relationship between our fully implemented frailty-based bedside Risk Analysis Index (RAI) and complications after CEA.

Methods: Patients undergoing CEA in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2011 were included. Variables of frailty RAI were matched to preoperative NSQIP variables, and outcomes including stroke, mortality, myocardial infarction (MI), and length of stay were analyzed. We further analyzed patients who were symptomatic and asymptomatic before CEA.

Results: With use of the NSQIP database, 44,832 patients undergoing CEA were analyzed (17,696 [39.5%] symptomatic; 27,136 [60.5%] asymptomatic). Increasing frailty RAI score correlated with increasing stroke, death, and MI (P < .0001) as well as with length of stay. RAI demonstrated increasing risk of stroke and death on the basis of risk stratification (low risk [0-10], 2.1%; high risk [>10], 5.0%). Among patients undergoing CEA, 88% scored low (<10) on the RAI. In symptomatic patients, the risk of stroke and death for patients with a score of ≤10 is 2.9%, whereas if the RAI score is 11 to 15, it is 5.0%; 16 to 20, 6.9%; and >21, 8.6%. In asymptomatic patients, the risk of stroke and death for patients with a score of ≤10 is 1.6%, whereas if the RAI score is 11 to 15, it is 2.9%; 16 to 20, 5.2%; and >21, 6.2%.

Conclusions: Frailty is a predictor of increased stroke, mortality, MI, and length of stay after CEA. An easily implemented RAI holds the potential to identify a limited subset of patients who are at higher risk for postoperative complications and may not benefit from CEA.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Asymptomatic Diseases
  • Carotid Artery Diseases / complications
  • Carotid Artery Diseases / diagnosis
  • Carotid Artery Diseases / mortality
  • Carotid Artery Diseases / surgery*
  • Databases, Factual
  • Decision Support Techniques*
  • Endarterectomy, Carotid / adverse effects*
  • Endarterectomy, Carotid / mortality
  • Female
  • Health Status Indicators*
  • Health Status*
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology
  • Myocardial Infarction / mortality
  • Patient Selection
  • Predictive Value of Tests
  • Risk Assessment
  • Risk Factors
  • Stroke / etiology
  • Stroke / mortality
  • Time Factors
  • Treatment Outcome
  • United States