The Modified Frailty Index Does Not Predict Mortality After Major Lower Extremity Amputation for Peripheral Arterial Disease in an Asian Population

Autor: Qing Wei Shaun Lee, Reuban Toby D'cruz, Zi Yin Priscilla Ting, Tze Tec Chong, Tjun Y. Tang, Ting Fang Tan, Hao Yun Yap, Ting Hway Wong
Rok vydání: 2019
Předmět:
Male
medicine.medical_specialty
Time Factors
Critical Illness
Frail Elderly
Population
030204 cardiovascular system & hematology
Risk Assessment
Amputation
Surgical
030218 nuclear medicine & medical imaging
03 medical and health sciences
Peripheral Arterial Disease
0302 clinical medicine
Asian People
Ischemia
Predictive Value of Tests
Risk Factors
Internal medicine
medicine
Humans
education
Geriatric Assessment
Aged
Retrospective Studies
Aged
80 and over
education.field_of_study
Singapore
Frailty
business.industry
Mortality rate
Retrospective cohort study
General Medicine
Critical limb ischemia
Perioperative
Middle Aged
medicine.disease
Treatment Outcome
Lower Extremity
Predictive value of tests
Cohort
Surgery
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Kidney disease
Zdroj: Annals of vascular surgery. 69
ISSN: 1615-5947
Popis: Background Patients with critical limb ischemia (CLI) who undergo major lower extremity amputation (LEA) have been associated with high one-year mortality rates. Previous western-based studies have identified risk factors that exponentiate these poor outcomes, including nonambulatory status and cardiovascular morbidity. We assessed the effect of frailty, using the modified frailty index (mFI) in a cohort undergoing major LEA for CLI to predict mortality, perioperative complications, and unplanned readmissions in a tertiary institution from Singapore. Methods Data on patients who had undergone major LEA from January 2016 to December 2017 were collected retrospectively. Inclusion criteria were below-knee amputations (BKAs) or above-knee amputations (AKAs) performed for peripheral arterial disease–related tissue loss or sepsis only. Patients were categorized into 3 risk groups based on the 11-variable mFI: low mFI, 0–0.27; moderate mFI, 0.36–0.54; and high mFI ≥0.63. Univariate and multivariate analysis was performed using logistic regression analysis. Results 211 patients underwent major LEA, of whom 133 (63.0%) had undergone BKA. The mean mFI was 0.41 (range 0-0.81). 84/211 (39.8%) died within 1 year after the procedure, with mortality rates of 25/65 (38.4%), 49/127 (38.6%), and 10/19 (52.6%) in the low-, moderate-, high-mFI categories, respectively. High and moderate mFI had failed to demonstrate an increased risk of mortality when compared with the low-mFI group (P > 0.05). 91/211 (43.1%) patients had perioperative complications, whereas 27/211 (12.8%) patients were readmitted within 30 days of discharge. Myocardial infarction, chronic kidney disease, and atrial fibrillation were found to be predictive of poor outcomes after major LEA. Conclusions Frailty as measured with the mFI did not predict outcome after major LEA. This could be due to confounding effects such as high prevalence of renal dysfunction and the constancy of diabetes and peripheral vascular disease in this population that would reduce the differentiation of patients using the mFI.
Databáze: OpenAIRE
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