The Impact of Frailty on Outcomes of Proximal Aortic Aneurysm Surgery: A Nationwide Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Database
2.2. Study Population and Definitions
2.3. Study Outcomes
2.4. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Clinical Outcomes
3.3. Multivariable Analysis in Frail Patients
3.4. Sensitivity Analysis
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Non-Frail (n = 5340) | Frail (n = 405) | p-Value | |
---|---|---|---|
Demographics | |||
Mean Age, years (SD) | 61.8 (0.4) | 68.7 (1.3) | <0.001 * |
Female [N (%)] | 1640 (30.7%) | 165 (40.7%) | <0.05 * |
Comorbidities [N (%)] | |||
Atrial Fibrillation | 1295 (24.3%) | 115 (28.4%) | 0.40 |
Coronary Artery Disease | 235 (4.4%) | 50 (12.3%) | <0.001 * |
Dyslipidemia | 2430 (45.5%) | 180 (44.4%) | 0.85 |
Prior Myocardial Infarction | 240 (4.5%) | 40 (9.9%) | 0.03 * |
Congestive Heart Failure | 1255 (23.5%) | 100 (24.7%) | 0.80 |
Chronic Pulmonary Disease | 1105 (20.7%) | 125 (30.9%) | 0.04 * |
Diabetes | 235 (4.4%) | 40 (9.9%) | 0.03 * |
Hypertension | 3635 (68.1%) | 250 (61.7%) | 0.24 |
Bicuspid Aortic Valve | 1285 (24.1%) | 45 (11.1%) | <0.01 * |
Chronic Kidney Disease | 605 (11.3%) | 90 (22.2%) | <0.01 * |
Prior CABG | 90 (1.7%) | 10 (2.5%) | 0.60 |
Number of Charlson Comorbidities [N (%)] | |||
One | 2360 (44.2%) | 75 (18.5%) | <0.001 * |
Two | 1745 (32.7%) | 120 (29.6%) | |
Three or more | 1235 (23.1%) | 210 (51.9%) | |
Frailty-Defining Conditions [N (%)] | |||
Malnutrition | 0 (0%) | 95 (23.5%) | |
Dementia | 0 (0%) | 260 (64.2%) | |
Impaired Vision | 0 (0%) | 0 (0%) | |
Sacral Ulcer | 0 (0%) | 20 (4.9%) | |
Urine Incontinence | 0 (0%) | 0 (0%) | |
Fecal Incontinence | 0 (0%) | 0 (0%) | |
Weight Loss | 0 (0%) | 10 (2.5%) | |
Lacking Social Support | 0 (0%) | 20 (4.9%) | |
Difficulty Walking | 0 (0%) | 25 (6.2%) | |
Mechanical Fall | 0 (0%) | 10 (2.5%) | |
Admission Characteristics | |||
Admission on Weekend | 145 (2.7%) | 35 (8.6%) | <0.01 * |
Elective Admission | 4425 (83.2%) | 275 (67.9%) | <0.01 * |
Transfer Status | |||
Not Transferred | 5060 (94.9%) | 360 (88.9%) | 0.07 |
Transferred From a Different Acute Care Hospital | 230 (4.3%) | 35 (8.6%) | |
Transferred From Another Type of Health Facility | 40 (0.8%) | 10 (2.5%) |
Non-Frail (n = 5340) | Frail (n = 405) | p-Value | |
---|---|---|---|
In-Hospital Outcomes | |||
MACE [N (%)] | 3265 (61.1%) | 355 (87.7%) | <0.01 * |
Acute Kidney Injury [N (%)] | 825 (15.4%) | 135 (33.3%) | <0.01 * |
Complete Heart Block [N (%)] | 330 (6.2%) | 45 (11.1%) | 0.07 |
Major Bleed [N (%)] | 2985 (55.9%) | 315 (77.8%) | <0.01 * |
Stroke [N (%)] | 135 (2.5%) | 35 (8.6%) | <0.01 * |
Death [N (%)] | 130 (2.4%) | 20 (4.9%) | 0.17 |
Pacemaker Insertion [N (%)] | 130 (2.4%) | 30 (7.4%) | <0.01 * |
Non-home Discharge [N (%)] | 2895 (54.3%) | 300 (74.1%) | <0.01 * |
LOS (Mean Days, SE) | 8.3 (0.2) | 17.0 (1.7) | <0.01 * |
Cost (Mean USD $, SE) | 228,573 (8855) | 419,515 (46,771) | <0.01 * |
Hospital Factors | |||
Bed Size [N (%)] | 0.78 | ||
Small | 405 (7.6%) | 30 (7.4%) | |
Medium | 835 (15.6%) | 75 (18.5%) | |
Large | 4100 (76.8%) | 300 (74.1%) | |
Ownership of Hospital [N (%)] | 0.77 | ||
Government, Nonfederal | 410 (7.7%) | 30 (7.4%) | |
Private, Not-for-Profit | 4630 (86.7%) | 345 (85.2%) | |
Private, Invest Own | 300 (5.6%) | 30 (7.4%) | |
Teaching Status of Hospital [N (%)] | -- | ||
Rural | 65 (1.2%) | 0 (0%) | |
Urban Non-Teaching | 395 (7.4%) | 10 (2.5%) | |
Urban Teaching | 4880 (91.4%) | 395 (97.5%) | |
Region of Hospital [N (%)] | 0.82 | ||
Northeast | 1210 (22.7%) | 100 (24.7%) | |
Midwest | 1375 (25.7%) | 105 (25.9%) | |
South | 1725 (32.3%) | 140 (34.6%) | |
West | 1030 (19.3%) | 60 (14.8%) |
Outcome | Odds Ratio | 95% Confidence Interval | p-Value | |
---|---|---|---|---|
Death | 1.40 | 0.43 | 4.50 | 0.575 |
Stroke | 1.61 | 0.11 | 23.75 | 0.727 |
Acute Kidney Injury | 2.09 | 1.13 | 3.84 | 0.018 * |
Pacemaker Insertion | 3.05 | 0.96 | 9.72 | 0.060 |
Complete Heart Block | 1.55 | 0.65 | 3.71 | 0.325 |
Major Bleeding | 2.63 | 1.47 | 4.67 | 0.001 * |
MACE | 4.29 | 1.88 | 9.78 | 0.001 * |
Variable | Odds Ratio | 95% Confidence Interval | p-Value | |
---|---|---|---|---|
Age | 1.02 | 0.97 | 1.08 | 0.45 |
Female | 0.47 | 0.18 | 1.26 | 0.13 |
Dyslipidemia | 0.20 | 0.07 | 0.62 | 0.005 * |
Bicuspid Aortic Valve | 0.81 | 0.20 | 3.22 | 0.75 |
Hypertension | 0.60 | 0.18 | 2.04 | 0.41 |
Chronic Pulmonary Disease | 2.15 | 0.94 | 4.93 | 0.07 |
Chronic Kidney Disease | 1.95 | 0.43 | 8.77 | 0.38 |
Coronary Artery Disease | 9.49 | 3.00 | 30.01 | <0.001 * |
Atrial Fibrillation | 0.80 | 0.29 | 2.20 | 0.66 |
Congestive Heart Failure | 2.15 | 0.96 | 4.85 | 0.064 |
Teaching Hospital | 0.27 | 0.08 | 0.94 | 0.039 * |
Prior CABG | 8.37 | 2.35 | 29.79 | 0.001 * |
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Percy, E.D.; Faggion Vinholo, T.; Newell, P.; Singh, S.; Hirji, S.; Awtry, J.; Semco, R.; Chowdhury, M.; Reed, A.K.; Asokan, S.; et al. The Impact of Frailty on Outcomes of Proximal Aortic Aneurysm Surgery: A Nationwide Analysis. J. Cardiovasc. Dev. Dis. 2024, 11, 32. https://doi.org/10.3390/jcdd11010032
Percy ED, Faggion Vinholo T, Newell P, Singh S, Hirji S, Awtry J, Semco R, Chowdhury M, Reed AK, Asokan S, et al. The Impact of Frailty on Outcomes of Proximal Aortic Aneurysm Surgery: A Nationwide Analysis. Journal of Cardiovascular Development and Disease. 2024; 11(1):32. https://doi.org/10.3390/jcdd11010032
Chicago/Turabian StylePercy, Edward D., Thais Faggion Vinholo, Paige Newell, Supreet Singh, Sameer Hirji, Jake Awtry, Robert Semco, Muntasir Chowdhury, Alexander K. Reed, Sainath Asokan, and et al. 2024. "The Impact of Frailty on Outcomes of Proximal Aortic Aneurysm Surgery: A Nationwide Analysis" Journal of Cardiovascular Development and Disease 11, no. 1: 32. https://doi.org/10.3390/jcdd11010032