O-058 - IMPACT OF FRAILTY ON TREATMENT OUTCOME FOR NON-RUPTURED ABDOMINAL AORTIC ANEURYSM: A NATIONAL VASCULAR REGISTRY COHORT STUDY.

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Rawashdeh M. (Imperial College London ~ London ~ United Kingdom) , Clark C. (Coventry University ~ Coventry ~ United Kingdom) , Javed A. (Imperial College London ~ London ~ United Kingdom) , Lane T. (Imperial College London ~ London ~ United Kingdom) , Sritharan G. (Imperial College London ~ London ~ United Kingdom) , Davies A. (Imperial College London ~ London ~ United Kingdom) , Davies A. (Imperial College London ~ London ~ United Kingdom)
Introduction:
Frailty is conceptually defined as a clinically recognizable state in which the ability of older people to cope with everyday or acute stressors is compromised by an increased vulnerability brought by age-associated declines in physiological reserve and function across multiple organ systems. The foundation of National Vascular Registry (NVR) has played an important role in improving surgical outcomes in patients undergoing abdominal aortic aneurysm (AAA) repair. In 2019, NVR introduced the recording of a frailty metric to patients undergoing AAA repair in recognition of its vital role and impact on patient outcomes. In this study, we aim to identify the incidence of frailty and its impact of treatment outcome for patients undergoing elective infrarenal AAA repair.
Methods:
We performed a retrospective analysis of National Vascular Registry data to discern the incidence of frailty in patients undergoing abdominal aortic aneurysm repair. We received data from National Vascular registry for patients who received treatment between 2019 and 2020. We analysed the baseline cohort and performed a subgroup analysis for each type of repair (Open, EVAR). We performed binary logistic regression to investigate the relationship between frailty ("frail" vs. "not frail"), baseline characteristics, and treatment outcomes.
Results:
A total of 4020 patients were included, after excluding patients who had no frailty score documented and patients who received complex repairs. 1666(41.4%) patients received Open repair. 28.4%(n=1142) of the cohort were frail (scored>=2) on the NVR frailty scale. After performing a subgroup analysis, we found that frail patients who received open repair were more likely to have postoperative complications (38.3% vs 24.50%; adjusted odds ratio (OR) 1.798, 95%CI 1.352-2.391), post-operative confusion (5.30%vs 1.80%; OR 2.621, 95%CI 1.308-5.251). In the EVAR group, postoperative complications, in general, were low in both ''frail'' and ''not frail'' groups (3.7% vs 4.3%) however Respiratory complications specifically were more statistically significant in the frail group (0.7% vs 0.5%; OR 2.476, 1.139-5.385). There was no significant difference in mortality in both subgroups between ''frail' and ''not frail'', however, it was higher in the frail group (Open repair 3.8% vs 2.1%; OR 1.551,95%CI 0.728-3.301; EVAR 0.2% vs 0.1%; OR 1.488, 95%CI 0.315-7.036).
Conclusion:
Frailty has a great impact on post operative morbidity. Validated frailty scoring should be utilised in the preoperative assessment to identify patients who at higher risk of developing complications. Future research should be focused on early identification of frail patients before intervention and explore the role of preoperative optimisation to reduce the impact of frailty.