Therapeutics and Clinical Risk Management (Oct 2019)
Frailty In Patients Undergoing Vascular Surgery: A Narrative Review Of Current Evidence
Abstract
Nikoletta Rahel Czobor,1,2 Jean-Jacques Lehot,3,4 Eniko Holndonner-Kirst,1 Phillip J Tully,5 Janos Gal,6 Andrea Szekely6,7 1Medical Centre of Hungarian Defense Forces, Department of Anesthesiology and Intensive Care, Budapest, Hungary; 2Semmelweis University, School of Doctoral Studies, Budapest, Hungary; 3Claude-Bernard University, Health Services and Performance Research Lab (EA 7425 HESPER), Lyon, France; 4Hôpital Neurologique Pierre Wertheimer, Department of Neuroanesthesia and Intensive Care, Hospices Civils de Lyon, Lyon, France; 5University of Adelaide, Freemasons Foundation Centre for Men’s Health, Adelaide, Australia; 6Semmelweis University, Department of Anesthesiology and Intensive Care, Budapest, Hungary; 7Semmelweis University, Heart and Vascular Center of Városmajor, Budapest, HungaryCorrespondence: Andrea SzekelyDepartment of Anaesthesiology and Intensive Therapy, Semmelweis University, Üllői út 78, Budapest 1082, HungaryTel +36206632243Email [email protected]: Frailty is presumably associated with an elevated risk of postoperative mortality and adverse outcome in vascular surgery patients. The aim of our review was to identify possible methods for risk assessment and prehabilitation in order to improve recovery and postoperative outcome. The literature search was performed via PubMed, Embase, OvidSP, and the Cochrane Library. We collected papers published in peer-reviewed journals between 2001 and 2018. The selection criterion was the relationship between vascular surgery, frailty and postoperative outcome or mortality. A total number of 52 publications were included. Frailty increases the risk of non-home discharge independently of presence or absence of postoperative complications and it is related to a higher 30-day mortality and major morbidity. The modified Frailty Index showed significant association with elevated risk for post-interventional stroke, myocardial infarction, prolonged in-hospital stays and higher readmission rates. When adjusted for comorbidity and surgery type, frailty seems to impact medium-term survival (within 2 years). Preoperative physical exercising, avoidance of hypalbuminemia, psychological and cognitive training, maintenance of muscle strength, adequate perioperative nutrition, and management of smoking behaviours are leading to a reduced length of stay and a decreased incidence of readmission rate, thus improving the effectiveness of early rehabilitation. Pre-frailty is a dynamically changing state of the patient, capable of deteriorating or improving over time. With goal-directed preoperative interventions, the decline can be prevented.Keywords: preoperative risk assessment, postoperative outcome, patient management, prehabilitation
