title: Frailty and poor functional status are common in arterial vascular surgical patients and affect postoperative outcomes.
abstract: OBJECTIVE
  Increasing numbers of older people are undergoing emergency and elective arterial vascular procedures. Many older patients are frail which is a recognised predictor of adverse postoperative outcomes in other surgical specialties. This study in older patients undergoing arterial vascular surgery examined; the prevalence of preoperative frailty; the clinical feasibility of preoperatively measuring frailty and functional status; the association between these characteristics and adverse postoperative outcome.
  
  
  METHODS
  Prospective observational study in patients aged over 60 years undergoing elective and emergency arterial vascular surgery. Baseline measures of frailty (Edmonton Frail Scale), functional status (gait velocity, timed up and go, hand grip strength) and cognitive function (Montreal Cognitive Assessment) were obtained preoperatively. The primary outcome measure Length of Stay (LOS) and secondary outcome measures of postoperative morbidity (medical and surgical complications), functional status and postoperative in-hospital mortality were recorded.
  
  
  RESULTS
  125 patients were recruited. Frailty was common in this older surgical population (52% EFS score of ≥ 6.5) with high frailty scores observed (mean EFS 6.6, SD 3.05) and poor functional status (60% had TUG > 15 s, 45% had gait velocity of < 0.6 m/s). Higher preoperative EFS (> 6.5) was univariately associated with longer LOS (≥ 12 days), composite measures of postoperative infections, postoperative medical complications and adverse functional outcomes. EFS ≥ 6.5 was predictive of LOS ≥ 12 days, adjusted for age (AUC 0.660, CI 0.541-0.779, p = 0.010). This association between EFS ≥ 6.5 and LOS ≥ 12 days was strengthened with the addition of MoCA < 24 (AUC 0.695, CI 0.584-0.806, p = 0.002).
  
  
  CONCLUSIONS
  Patients aged over 60 years admitted for arterial vascular surgery were frail, had impaired functional status and were cognitively impaired. This combination of preoperative characteristics was predictive of longer hospital length of stay and associated with adverse postoperative outcome.
authors.affiliation: Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, 9th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK; Division of Health and Social Care Research, Kings College London, 7th Floor Capital House, 42 Weston Street, London SE1 3QD, UK. Electronic address: judith.partridge@gstt.nhs.uk.
authors.forename: Judith S L
authors.initials: JS
authors.lastname: Partridge
authors.affiliation: Department of Physiotherapy, Guy's and St Thomas' NHS Foundation Trust, 3rd Floor, Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Fuller
authors.affiliation: Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, 9th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK; Division of Health and Social Care Research, Kings College London, 7th Floor Capital House, 42 Weston Street, London SE1 3QD, UK.
authors.forename: Danielle
authors.initials: D
authors.lastname: Harari
authors.affiliation: Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, 1st Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Taylor
authors.affiliation: Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, 9th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK; Institute of Gerontology, Kings College London, Room K4L.25, Strand Campus, Strand, London WC2R 2LS, UK.
authors.forename: Finbarr C
authors.initials: FC
authors.lastname: Martin
authors.affiliation: Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, 9th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK; Division of Health and Social Care Research, Kings College London, 7th Floor Capital House, 42 Weston Street, London SE1 3QD, UK.
authors.forename: Jugdeep K
authors.initials: JK
authors.lastname: Dhesi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D018737:Hand Strength; D006299:Health Services for the Aged; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011184:Postoperative Period; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013222:State Medicine; D014656:Vascular Surgical Procedures
keywords: Arterial vascular surgery; Frailty; Functional status; Older people; Outcomes