title: Preoperative frailty is predictive of complications after major lower extremity amputation.
abstract: OBJECTIVE
  Preoperative clinical frailty is increasingly used as a surrogate for predicting postoperative outcomes. Patients undergoing major lower extremity amputation (LEA) carry a high risk of perioperative morbidity and mortality, including high 30-day mortality and readmission rates. We hypothesized that preoperative frailty would be associated with an increased risk of postoperative mortality and readmission.
  
  
  METHODS
  A retrospective review was performed for all patients who underwent transfemoral or transtibial amputation for any indication within a multi-institution system during a 5-year period. Standard demographics and all components of the Modified Frailty Index (mFI) were used to determine preoperative frailty status for each patient. The primary outcome was 30-day mortality, with secondary outcomes of 30-day readmission, unplanned revision, and composite adverse events.
  
  
  RESULTS
  Among 379 patients who underwent LEA, the overall readmission and mortality rates for the group were 22.69% and 6.06%, respectively. Readmission rates increased with increasing mFI score: rates were 8.6%, 13.5%, 16.3%, 19.7%, 31.4%, and 37.0% for mFI scores of 0, 1, 2, 3, 4, and ≥5, respectively (P = .015). On multivariate logistic regression, only mFI (odds ratio, 1.49, 95% confidence interval, 1.24-1.77) and sex (odds ratio, 1.81, 95% confidence interval, 1.00-2.98) were significant predictors of 30-day readmission.
  
  
  CONCLUSIONS
  Preoperative clinical frailty is associated with an increased 30-day readmission rate in patients undergoing LEA and should be incorporated into preoperative counseling and risk stratification, as well as postoperative planning and care.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Emory University, Atlanta, Ga. Electronic address: zbfang@emory.edu.
authors.forename: Zachary B
authors.initials: ZB
authors.lastname: Fang
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Emory University, Atlanta, Ga.
authors.forename: Frances Y
authors.initials: FY
authors.lastname: Hu
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Emory University, Atlanta, Ga.
authors.forename: Shipra
authors.initials: S
authors.lastname: Arya
authors.affiliation: Department of Surgery, Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Ga.
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Gillespie
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Emory University, Atlanta, Ga.
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Rajani
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006304:Health Status; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D018579:Patient Selection; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D019233:Retreatment; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult