title: Gender and frailty predict poor outcomes in infrainguinal vascular surgery.
abstract: BACKGROUND
  Women have poorer outcomes after vascular surgery as compared to men as shown by studies recently. Frailty is also an independent risk factor for postoperative morbidity and mortality. This study examines the interplay of gender and frailty on outcomes after infrainguinal vascular procedures.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program database was used to identify all patients who underwent infrainguinal vascular procedures from 2005-2012. Frailty was measured using a modified frailty index (mFI; derived from the Canadian Study of Health and Aging). Univariate and multivariate analysis were performed to investigate the association of preoperative frailty and gender, on postoperative outcomes.
  
  
  RESULTS
  Of 24,645 patients (92% open, 8% endovascular), there were 533 deaths (2.2%) and 6198 (25.1%) major complications within 30 d postoperatively. Women were more frail (mean mFI = 0.269) than men (mean mFI = 0.259; P < 0.001). Women and frail patients (mFI>0.25) were more likely to have a major morbidity (P < 0.001) or mortality (P < 0.001) with the highest risk in frail women. On multivariate logistic regression analysis, female gender and increasing mFI were independently significantly associated with mortality (P < 0.05) as well as major complications. The interaction of gender and frailty in multivariate analysis showed the highest adjusted 30-d mortality and morbidity in frail females at 2.8% and 30.1%, respectively and that was significantly higher (P < 0.001) than nonfrail males, nonfrail females and frail males.
  
  
  CONCLUSIONS
  Female gender and frailty are both associated with increased risk of complications and death following infrainguinal vascular procedures with the highest risk in frail females. Further studies are needed to explore the mechanisms of interaction of gender and frailty and its effect on long-term outcomes for peripheral vascular disease.
authors: Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, Georgia.
authors: Reshma
authors: R
authors: Brahmbhatt
authors: Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, Georgia; Surgical Service Line, Atlanta VA Medical Center, Decatur, Georgia.
authors: Luke P
authors: LP
authors: Brewster
authors: Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, Georgia.
authors: Susan
authors: S
authors: Shafii
authors: Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, Georgia.
authors: Ravi R
authors: RR
authors: Rajani
authors: Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, Georgia.
authors: Ravi
authors: R
authors: Veeraswamy
authors: Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, Georgia; Surgical Service Line, Atlanta VA Medical Center, Decatur, Georgia.
authors: Atef
authors: A
authors: Salam
authors: Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, Georgia.
authors: Thomas F
authors: TF
authors: Dodson
authors: Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, Georgia; Surgical Service Line, Atlanta VA Medical Center, Decatur, Georgia. Electronic address: shipra.arya@emory.edu.
authors: Shipra
authors: S
authors: Arya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000401:mortality*
keywords: Complications; Frailty; Gender; Infrainguinal bypass; Outcomes; Revascularization