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Analysis

Predict Vascular Surgery Outcomes With This Simple Frailty Test

By Christopher Cheney  
   November 26, 2018

The Clinical Frailty Scale assessment can be performed in less than a minute and indicates likelihood of post-surgical mortality and loss of independence.

Prior to vascular surgery, an easy nine-point frailty test can predict non-home discharge as well as long- and short-term mortality risk, recent research shows.

Vascular surgery, such as abdominal aortic aneurysm repair, often involves high-risk procedures, particularly for frail patients. Tools that can predict surgical outcomes can help vascular surgery practices enhance transitions of care, inform patient decision-making, and set patient expectations.

The researchers used the Clinical Frailty Scale (CFS), which can assess frailty in less than a minute, to predict loss of independence after major vascular procedures.

"The CFS is a practical tool for assessing preoperative frailty among patients undergoing elective major vascular surgery and can be used to predict likelihood of requiring discharge to a nursing facility or death after surgery. The identification of frail patients before major surgery can help manage postoperative expectations and optimize transitions of care," the research wrote this month in the Journal of Vascular Surgery.

The CFS rates frailty on a scale of 1 to 9. In the study, patients with CFS scores greater than or equal to 5 were considered frail.

The study featured 134 independent patients who were assessed with the CFS before undergoing seven vascular surgery procedures, including open abdominal aortic aneurysm repair, endovascular aneurysm repair, and carotid endarterectomy.

Frail patients were found to be at higher risk for several negative outcomes.

  • 62% of frail patients needed mobility assistance after surgery compared to 22% of non-frail patients
     
  • 22% of frail patients were discharged to a non-home location compared to 6% of non-frail patients
     
  • 8% of frail patients died within 30 days after surgery compared to 0% of non-frail patients
     
  • Frail patients faced more than a 12-fold higher risk of 30-day mortality or loss of independence.
     
  • Frail patients experienced a significantly longer hospital length of stay (6.4 days) compared to non-frail patients (4.2 days)

Multiple benefits
 

The ability of CFS to predict post-surgical outcomes has high value for vascular surgery practices and their patients, the researchers wrote.

"The decision to subject a frail patient to surgical stress associated with a major vascular procedure may result in a physiologic decompensation and lead to morbidity, loss of functional independence … or death, a conceptual framework that has been called the disablement process," they wrote. "Moreover, providing information on the risk for loss of independence or mortality before surgery is important as it may influence a patient's decision to undergo an elective vascular procedure."

Utilizing CFS scores can help vascular surgery practices enhance transitions of care, the corresponding author for the research told HealthLeaders.

"For patients electing to undergo surgery, sharing this information up front allows them and their families to prepare for the fact that they will not be going home immediately after surgery. As such, the CFS provides important data that helps patients prepare and optimize their transitions of care before and after surgery," said Benjamin Brooke, MD, PhD, chief of the Division of Vascular Surgery, Department of Surgery, University of Utah Health.

The CFS assessment tool is valuable for vascular surgery practices, Brooke said. "The CFS provides a fast, easy, and validated method to identify frailty and risk stratify every patient you encounter in clinic, emergency departments, or on the hospital wards," he said.

For vascular surgery practices, the CFS is a superior option to other frailty assessment tools, Brooke and his coauthors wrote.

"Although it is well recognized that risk assessment is an essential component of the preoperative surgical workup, most risk calculators are either too cumbersome or time-intensive to be employed on a routine basis in outpatient clinical settings. In comparison, the CFS score is a simple eyeball test that can be easily measured on all patients in conjunction with other vital signs collected during clinic visits," they wrote.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

For major vascular surgery procedures, frailty is associated with several negative outcomes, including need for mobility assistance.

The Clinical Frailty Scale is a quick and easy assessment tool for vascular surgery patients.

The value of the Clinical Frailty Scale for vascular surgery patients includes enhancing transitions of care.


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