R. Brahmbhatt1, L. Brewster1,2, S. Shafii1,3, R. Rajani1,3, R. Veeraswamy1, A. Salam1,2, T. Dodson1, S. Arya1,2 1Emory University School Of Medicine,Atlanta, GA, USA 2Atlanta VAMC,Decatur, GA, USA 3Grady Memorial Hospital,Atlanta, GEORGIA [GA], USA
Introduction: Women are a high-risk group for postoperative complications and mortality after infrainguinal vascular interventions. Frailty has been shown in recent studies to be an independent risk factor for postoperative morbidity and mortality. This study examines the interplay of gender and frailty as well as their effect on outcomes following infrainguinal vascular procedures.
Methods: The NSQIP database was used to identify all patients who underwent infrainguinal vascular procedures from 2005-2012 (endovascular procedures recorded after 2010). Preoperative frailty was measured using the modified frailty index (mFI; derived from the Canadian Study of Health and Aging). Univariate and multivariate analysis was performed to investigate the association of preoperative frailty and gender, on postoperative complications and death.
Results: Of 24,645 patients who underwent infrainguinal vascular procedures (92% open, 8% endovascular), there were 533 deaths (2.2%) and 6198 (25.1%) major complications within 30 days postoperatively. The population had 8,868 (36%) women with a mean mFI [range 0-11] of 0.269 as compared to mFI of 0.259 in males (p<0.001). Women as well as frail patients (mFI>0.2) were more likely to have a major morbidity (p<0.001) or mortality (p<0.001) in univariate analysis. Frail women had the highest risk of death and major complications [Figure 1]. On multivariate logistic regression analysis, female gender [odds ratio (OR) 1.23; 95% confidence interval (CI) (1.1, 1.6)], age [OR 1.05, 95% CI (1.04-1.06)], ASA class [OR 2.0, 95% CI (1.6-2.5)] and increasing mFI [OR 1.25, 95% CI (1.15-1.4)] were significantly associated with mortality (p<0.05) after adjusting for other covariates. Major complications were also significantly associated (p<0.05) with female gender [OR 1.4, 95% CI (1.3-1.5)], ASA class [OR 1.3, 95% CI (1.17-1.4)], and increasing mFI [OR 1.12, 95% CI (1.1-1.16)] after adjusting for other covariates. Using stratified multivariate analysis based on gender, the presence of frailty resulted in slightly higher odds of death in women as compared to men (OR 1.75 vs. OR 1.6) whereas the increased odds of complications with presence of frailty were similar in both genders (OR 1.3).
Conclusion: Women undergoing infrainguinal procedures are more frail than men. Female gender and frailty are both associated with increased risk of complications and death following infrainguinal vascular procedures after controlling for other covariates in multivariate analysis. Further studies are needed to explore the interaction of gender and frailty and its effect on long term outcomes for peripheral vascular disease.
