Frailty is a multi-domain syndrome characterised by reduced ability to cope with physiological stressors and associated with worse outcomes after surgery. One of the factors strongly related to frailty is sarcopenia - a predominantly age-related loss of muscle strength and mass. Assessment of sarcopenia and frailty is reproducible, cheap and does not require specialist equipment. The aim of this study was to report on potential clinical usefulness of assessment of frailty and sarcopenia in supporting decision-making in patients with aortic aneurysms.

All consecutive patients with aortic aneurysms seen in the specialist aortic clinic between Jul 2019 and Apr 2020 were assessed objectively for preventative, corrective surgery. All patients underwent a battery of objective, routine tests including CPET and pulmonary function tests. Frailty (Rockwood Clinical Frailty Scale), cognitive status (Abbreviated Mental Test), and quality of life (EQ-5D-5L) were assessed by Vascular Specialist Nurses as part of routine clinical practice. Patients were screened for sarcopenia using SARC-F questionnaire; core muscle mass was measured on CT angiograms. The decision regarding suitability/fitness for intervention was made by Multi-Disciplinary Team (MDT) consisting of anaesthetists, vascular surgeons, interventional radiologists and specialist nurses based on objective assessment of fitness. THE MDT was blinded to frailty assessment. The primary outcome was one year mortality.

We assessed 84 patients (median age 75 [72,82], 85% male; median aneurysm diameter 6cm [5.8,7.0]; 22% infrarenal, 46% juxtarenal and 32% thoracoabdominal aneurysms). Following objective assessment seventeen patients were deemed not fit for surgery; 41% of these were frail compared with 14% out of those who were deemed fit. Forty-eight patients underwent surgery (57%), 17(20%) did not, and 2(2%) declined despite being deemed fit. Eleven patients (13%) died within one year of assessment. Multivariable analysis that included frailty, presence of sarcopenia, myopenia and MDT decision on fitness for surgery, demonstrated that only frailty was associated with mortality (OR 10.3, 95%CI 1.8,64.9, p=0.008) irrespective of management strategy. After correcting for individual parameters including age, sex, CPET outcomes, and pulmonary function tests frailty was still independently associated with higher risk of dying within a year of assessment irrespective of management strategy (OR 11.4, 95%CI 1.27-101.9, p=0.030).

Assessment of frailty may be useful in deciding on appropriateness of surgical intervention in patients with aortic aneurysms.