Objective To describe and critique tools used to assess frailty in vascular surgery patients, and
investigate its associations with patient factors and outcomes. Background Increasing evidence shows negative impacts of frailty on outcomes in surgical
patients, but little investigation of its associations with patient factors has been
undertaken.
Methods Systematic review and meta-analysis of studies reporting frailty in vascular surgery
patients (PROSPERO registration: CRD42018116253) searching Medline, Embase,
CINAHL, PsycINFO and Scopus. Quality of studies was assessed using Newcastle Ottawa scores (NOS) and quality of evidence using GRADE criteria. Associations of
frailty with patient factors were investigated by difference in means (MD) or
expressed as risk ratios (RR), and associations with outcomes expressed as odds
ratios (OR) or hazard ratios (HR). Data were pooled using random effects models.
Results Fifty-three studies were included in the review and only 8 (15%) were both good
quality (NOS ≥7) and used a well-validated frailty measure. Eighteen studies (62,976
patients) provided data for the meta-analysis. Frailty was associated with increased
age (MD 4.05 years; 95% confidence interval [CI] 3.35, 4.75), female sex (RR 1.32;
95%CI 1.14, 1.54), and lower body-mass index (MD -1.81; 95%CI -2.94, -0.68).
Frailty was associated with 30-day mortality (adjusted [A]OR 2.77; 95%CI 2.01-3.81),
post-operative complications (AOR 2.16; 95%CI 1.55, 3.02) and long-term mortality
(HR 1.85; 95%CI 1.31, 2.62). Sarcopenia was not associated with any outcomes. Conclusion Frailty, but not sarcopenia, is associated with worse outcomes in vascular surgery
patients. Well-validated frailty assessment tools should be preferred clinically, and in
future research.</div