The Impact of Frailty on Outcomes of Proximal Aortic Aneurysm Surgery: A Nationwide Analysis

Edward D Percy; Thais Faggion Vinholo; Paige Newell; Supreet Singh; Sameer Hirji; Jake Awtry; Robert Semco; Muntasir Chowdhury; Alexander K Reed; Sainath Asokan; Alexandra Malarczyk; Alexis Okoh; Morgan Harloff; Farhang Yazdchi; Tsuyoshi Kaneko; Ashraf A Sabe

doi:10.3390/jcdd11010032

The Impact of Frailty on Outcomes of Proximal Aortic Aneurysm Surgery: A Nationwide Analysis

J Cardiovasc Dev Dis. 2024 Jan 20;11(1):32. doi: 10.3390/jcdd11010032.

Authors

Edward D Percy^{1

2}, Thais Faggion Vinholo^{1

2}, Paige Newell¹, Supreet Singh³, Sameer Hirji¹, Jake Awtry¹, Robert Semco¹, Muntasir Chowdhury⁴, Alexander K Reed⁵, Sainath Asokan⁶, Alexandra Malarczyk¹, Alexis Okoh⁷, Morgan Harloff¹, Farhang Yazdchi⁸, Tsuyoshi Kaneko⁹, Ashraf A Sabe¹

Affiliations

¹ Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
² Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA.
³ Department of Internal Medicine, Mount Sinai Hospital, New York, NY 10029, USA.
⁴ Department of Internal Medicine, Trinity Health System, Steubenville, OH 43952, USA.
⁵ Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94304, USA.
⁶ Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, PA 19134, USA.
⁷ Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30322, USA.
⁸ Division of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48109, USA.
⁹ Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University in St Louis, St. Louis, MO 63110, USA.

Abstract

(1) Background: This study examines frailty's impact on proximal aortic surgery outcomes. (2) Methods: All patients with a thoracic aortic aneurysm who underwent aortic root, ascending aorta, or arch surgery from the 2016-2017 National Inpatient Sample were included. Frailty was defined by the Adjusted Clinical Groups Frailty Indicator. Outcomes of interest included in-hospital mortality and a composite of death, stroke, acute kidney injury (AKI), and major bleeding (MACE). (3) Results: Among 5745 patients, 405 (7.0%) met frailty criteria. Frail patients were older, with higher rates of chronic pulmonary disease, diabetes, and chronic kidney disease. There was no difference in in-hospital death (4.9% vs. 2.4%, p = 0.169); however, the frail group exhibited higher rates of stroke and AKI. Frail patients had a longer length of stay (17 vs. 8 days), and higher rates of non-home discharge (74.1% vs. 54.3%) than non-frail patients (both p < 0.001). Sensitivity analysis confirmed increased morbidity and mortality in frail individuals. After adjusting for patient comorbidities and hospital characteristics, frailty independently predicted MACE (OR 4.29 [1.88-9.78], p = 0.001), while age alone did not (OR 1.00 [0.99-1.02], p = 0.568). Urban teaching center status predicted a lower risk of MACE (OR 0.27 [0.08-0.94], p = 0.039). (4) Conclusions: Frailty is associated with increased morbidity in proximal aortic surgery and is a more significant predictor of mortality than age. Coordinated treatment in urban institutions may enhance outcomes for this high-risk group.

Keywords: aortic aneurysm; aortic surgery; frailty.

Grants and funding

The authors express their sincere appreciation for the generous sponsorship and support provided by Department Funds, the University of British Columbia Clinician Investigator Program, and the Bulens family. Their financial contribution played a pivotal role in facilitating this research by covering the salaries of Edward Percy and Thais Faggion Vinholo, respectively, during the performance of this study.