O-047 - PREDICTORS OF ADVERSE OUTCOMES AND MORTALITY AFTER OPEN SURGICAL REPAIR OF PROXIMAL ABDOMINAL AORTIC ANEURYSMS: THE FIVE-FACTORS MODIFIED FRAILTY INDEX (M-FI-5) ROLE

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Mascia D. (Vita-Salute San Raffaele University ~ Milano ~ Italy) , Santoro A. (Vita-Salute San Raffaele University ~ Milano ~ Italy) , Saracino C. (Vita-Salute San Raffaele University ~ Milano ~ Italy) , Favia N. (Vita-Salute San Raffaele University ~ Milano ~ Italy) , Kahlberg A. (Vita-Salute San Raffaele University ~ Milano ~ Italy) , Chiesa R. (Vita-Salute San Raffaele University ~ Milano ~ Italy) , Melissano G. (Vita-Salute San Raffaele University ~ Milano ~ Italy)
Introduction:
"Frailty" is defined as "a multidimensional syndrome of decreased reserve and resistance to stressors" and it has been associated to adverse outcomes in several fields of surgery. The aim of the study was to evaluate the correlation between frailty, measured by the Five-Factor Modified Frailty Index (mFI-5) and all major adverse events (MAE), 30-day and mid-term mortality in patients who underwent proximal abdominal aortic aneurysm (p-AAA) open surgery (OS).
Methods:
data of all consecutive patients submitted to p-AAA OS from 2010 to 2021 were prospectively collected and retrospectively analyzed. Primary endpoints were 30-day mortality and major adverse events (MAE) and secondary endpoints included post-operative acute kidney injury (AKI), freedom from aortic reintervention and overall survival at mid-term follow-up. The impact of frailty was assessed by univariate and multivariate regression analysis; mid-term freedom from aortic reintervention and overall survival were estimated using Kaplan-Meier method.
Results:
Two-hundred twenty-one patients (177 M, 24 F; 72.2±7.4) were included. Thirty-seven (16.4%) were octogenarians (> 80 y). The Five-factor Modified Frailty Index was assessed in the entire group: mean mFI-5 was 0.29 ± 0.12. One-hundred patients (100/221, 45.25%) were defined "frail" considering the mFI-5 cut-off > 0.25 (Table 1). At univariate analysis mFI-5 > 0.25 was found to be a predictive factor for mid-term mortality (Pearson correlation(r):0.280, p<0.001) and AKI (Pearson correlation: 0.146, p:0.030). At multivariate analysis mFI-5 > 0.25 significantly increased the risk for midterm mortality (odds ratio (OR) 3.32, CI 1.81 - 6.09) and post-operative AKI (OR 2.09, CI 0.89 - 4.94).) The effect of mFI-5> 0.25 on mid-term mortality persisted after adjustment for age (p<0.001). Survival and freedom from reintervention rates were estimated with Kaplan-Meyer method: at a mean follow-up of 52.7 months (Confidence interval [CI] 95% 48.6-56.8) 68 (68/221 - 30.7%) deaths were recorded: 23 among non-frail patients (23/121, 19,0%) and 45 among frail patients (45/100, 45%, p < 0.001) (Fig 1); similar analysis were conducted comparing non-octogenarian and octogenarian patients: fifty-three in < 80 y (53/184 - 28.0%, p:NS) and 15 in > 80 y (15/37 - 38.0%, p:NS) with an overall 5 years survival of 69.3% (158/221) and a freedom from reintervention rate of 96.4% (213/221). (Fig 1)
Conclusion:
These results suggest that mFI-5 is a potential index tool capable to identify "frail" patients, who appear to be at increased risk of post-operative AKI and mid-term mortality after p-AAA open repair. Five-factor modified Frailty Index assessment is simple, fast and can be widely applied in surgical practice to perform appropriate risk stratifications and predict post-operative complications in patients candidate to p-AAA OS.
ATTACHMENTS: