title: Preoperative frailty Risk Analysis Index to stratify patients undergoing carotid endarterectomy.
abstract: OBJECTIVE
  Rapid and objective preoperative assessment of patients undergoing carotid endarterectomy (CEA) remains problematic. Preoperative variables correlate with increased morbidity and mortality, yet no easily implemented tool exists to stratify patients. We determined the relationship between our fully implemented frailty-based bedside Risk Analysis Index (RAI) and complications after CEA.
  
  
  METHODS
  Patients undergoing CEA in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2011 were included. Variables of frailty RAI were matched to preoperative NSQIP variables, and outcomes including stroke, mortality, myocardial infarction (MI), and length of stay were analyzed. We further analyzed patients who were symptomatic and asymptomatic before CEA.
  
  
  RESULTS
  With use of the NSQIP database, 44,832 patients undergoing CEA were analyzed (17,696 [39.5%] symptomatic; 27,136 [60.5%] asymptomatic). Increasing frailty RAI score correlated with increasing stroke, death, and MI (P < .0001) as well as with length of stay. RAI demonstrated increasing risk of stroke and death on the basis of risk stratification (low risk [0-10], 2.1%; high risk [>10], 5.0%). Among patients undergoing CEA, 88% scored low (<10) on the RAI. In symptomatic patients, the risk of stroke and death for patients with a score of ≤10 is 2.9%, whereas if the RAI score is 11 to 15, it is 5.0%; 16 to 20, 6.9%; and >21, 8.6%. In asymptomatic patients, the risk of stroke and death for patients with a score of ≤10 is 1.6%, whereas if the RAI score is 11 to 15, it is 2.9%; 16 to 20, 5.2%; and >21, 6.2%.
  
  
  CONCLUSIONS
  Frailty is a predictor of increased stroke, mortality, MI, and length of stay after CEA. An easily implemented RAI holds the potential to identify a limited subset of patients who are at higher risk for postoperative complications and may not benefit from CEA.
authors.affiliation: Department of Surgery, Nebraska-Western Iowa VA Medical Center, Omaha, Neb; Department of Surgery, University of Nebraska Medical Center, Omaha, Neb.
authors.forename: Alyson A
authors.initials: AA
authors.lastname: Melin
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, Neb.
authors.forename: Kendra K
authors.initials: KK
authors.lastname: Schmid
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, Neb.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Lynch
authors.affiliation: Department of Surgery, Nebraska-Western Iowa VA Medical Center, Omaha, Neb; Department of Surgery, University of Nebraska Medical Center, Omaha, Neb.
authors.forename: Iraklis I
authors.initials: II
authors.lastname: Pipinos
authors.affiliation: Department of Surgery, Aurora Healthcare System, Milwaukee, Wisc.
authors.forename: Steven
authors.initials: S
authors.lastname: Kappes
authors.affiliation: Department of Surgery, Nebraska-Western Iowa VA Medical Center, Omaha, Neb; Department of Surgery, University of Nebraska Medical Center, Omaha, Neb.
authors.forename: G Matthew
authors.initials: GM
authors.lastname: Longo
authors.affiliation: Department of Surgery, Methodist University Hospital and The University of Tennessee Health Science Center, Memphis, Tenn.
authors.forename: Prateek K
authors.initials: PK
authors.lastname: Gupta
authors.affiliation: Department of Surgery, Nebraska-Western Iowa VA Medical Center, Omaha, Neb; Department of Surgery, University of Nebraska Medical Center, Omaha, Neb. Electronic address: jjohanning@unmc.edu.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Johanning
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D003661:Decision Support Techniques; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D018579:Patient Selection; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States