Scoping review of frailty in vascular surgery

Scoping review of frailty in vascular surgery. Drudi LM, Ades M, Landry T, Gill HL, Grenon SM, Steinmetz OK, Afilalo J. Journal of Vascular Surgery 2019 Jun;69(6): 1989-1998

What is already known:
Preoperative risk stratification for surgical procedures is key to informed decision-making for patients undergoing interventions for vascular diagnoses. However, traditional risk prediction models focus on factors such as age and comorbidities and fail to account for the physiologic reserve that significantly impacts a patient’s risk for complications and recovery following procedure. Frailty assessments can provide information on the physiologic reserve that a patient has and their vulnerability to stressors. Frailty assessments can therefore provide complementary information to traditional preoperative risk assessments by improving the ability to predict functional recovery and quality of life after surgery. Frailty assessments may be particularly applicable in vascular surgery patients as they are typically older with multiple comorbidities and physical limitations. Although not a standard component of enhanced recovery after surgery (ERAS), there may be an opportunity to incorporate frailty assessments in ERAS pathways to enhance discussions of postoperative expectations or to prompt preoperative interventions to counter the effects of frailty.

What this paper adds:
This paper identified current frailty assessments in vascular surgery patients, the extent of the evidence base and recurring themes and gaps in the literature related to frailty in vascular surgery. There are multiple methods that have been employed to assess frailty in vascular surgery patients and the method impacts the prevalence (. In patients with vascular disease and in particular symptomatic peripheral arterial disease (PAD), it can be challenging to differentiate between baseline frailty and impairments from their disease, particularly if their presentation is acute. However, regardless of the frailty assessment used, frail patients who undergo common vascular procedures have increased risk of mortality, morbidity and other adverse outcomes such as cognitive impairment and functional impairment. Future directions include identification of the ideal frailty score for vascular surgery patients and to determine how a specific score correlates with operative risk. Improved diagnostic and prognostic capability of specific frailty scores can then provide additional opportunity to study how to care for frail patients undergoing vascular surgery.