The Impact of Frailty on Outcomes of Proximal Aortic Aneurysm Surgery: A Nationwide Analysis
(1) Background: This study examines frailty’s impact on proximal aortic surgery outcomes. (2) Methods: All patients with a thoracic aortic aneurysm who underwent aortic root, ascending aorta, or arch surgery from the 2016–2017 National Inpatient Sample were included. Frailty was defined by the Adjus...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-01-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/11/1/32 |
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| author | Edward D. Percy Thais Faggion Vinholo Paige Newell Supreet Singh Sameer Hirji Jake Awtry Robert Semco Muntasir Chowdhury Alexander K. Reed Sainath Asokan Alexandra Malarczyk Alexis Okoh Morgan Harloff Farhang Yazdchi Tsuyoshi Kaneko Ashraf A. Sabe |
| author_facet | Edward D. Percy Thais Faggion Vinholo Paige Newell Supreet Singh Sameer Hirji Jake Awtry Robert Semco Muntasir Chowdhury Alexander K. Reed Sainath Asokan Alexandra Malarczyk Alexis Okoh Morgan Harloff Farhang Yazdchi Tsuyoshi Kaneko Ashraf A. Sabe |
| author_sort | Edward D. Percy |
| collection | DOAJ |
| description | (1) Background: This study examines frailty’s impact on proximal aortic surgery outcomes. (2) Methods: All patients with a thoracic aortic aneurysm who underwent aortic root, ascending aorta, or arch surgery from the 2016–2017 National Inpatient Sample were included. Frailty was defined by the Adjusted Clinical Groups Frailty Indicator. Outcomes of interest included in-hospital mortality and a composite of death, stroke, acute kidney injury (AKI), and major bleeding (MACE). (3) Results: Among 5745 patients, 405 (7.0%) met frailty criteria. Frail patients were older, with higher rates of chronic pulmonary disease, diabetes, and chronic kidney disease. There was no difference in in-hospital death (4.9% vs. 2.4%, <i>p</i> = 0.169); however, the frail group exhibited higher rates of stroke and AKI. Frail patients had a longer length of stay (17 vs. 8 days), and higher rates of non-home discharge (74.1% vs. 54.3%) than non-frail patients (both <i>p</i> < 0.001). Sensitivity analysis confirmed increased morbidity and mortality in frail individuals. After adjusting for patient comorbidities and hospital characteristics, frailty independently predicted MACE (OR 4.29 [1.88–9.78], <i>p</i> = 0.001), while age alone did not (OR 1.00 [0.99–1.02], <i>p</i> = 0.568). Urban teaching center status predicted a lower risk of MACE (OR 0.27 [0.08–0.94], <i>p</i> = 0.039). (4) Conclusions: Frailty is associated with increased morbidity in proximal aortic surgery and is a more significant predictor of mortality than age. Coordinated treatment in urban institutions may enhance outcomes for this high-risk group. |
| first_indexed | 2024-03-08T10:46:25Z |
| format | Article |
| id | doaj.art-94c4d2998191432790b77f2d6d478dac |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-08T10:46:25Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-94c4d2998191432790b77f2d6d478dac2024-01-26T17:05:22ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252024-01-011113210.3390/jcdd11010032The Impact of Frailty on Outcomes of Proximal Aortic Aneurysm Surgery: A Nationwide AnalysisEdward D. Percy0Thais Faggion Vinholo1Paige Newell2Supreet Singh3Sameer Hirji4Jake Awtry5Robert Semco6Muntasir Chowdhury7Alexander K. Reed8Sainath Asokan9Alexandra Malarczyk10Alexis Okoh11Morgan Harloff12Farhang Yazdchi13Tsuyoshi Kaneko14Ashraf A. Sabe15Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USADivision of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USADivision of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USADepartment of Internal Medicine, Mount Sinai Hospital, New York, NY 10029, USADivision of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USADivision of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USADivision of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USADepartment of Internal Medicine, Trinity Health System, Steubenville, OH 43952, USADepartment of Cardiothoracic Surgery, Stanford University, Stanford, CA 94304, USADepartment of Pediatrics, St. Christopher’s Hospital for Children, Philadelphia, PA 19134, USADivision of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USADivision of Cardiology, Emory University School of Medicine, Atlanta, GA 30322, USADivision of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USADivision of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48109, USADivision of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University in St Louis, St. Louis, MO 63110, USADivision of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA(1) Background: This study examines frailty’s impact on proximal aortic surgery outcomes. (2) Methods: All patients with a thoracic aortic aneurysm who underwent aortic root, ascending aorta, or arch surgery from the 2016–2017 National Inpatient Sample were included. Frailty was defined by the Adjusted Clinical Groups Frailty Indicator. Outcomes of interest included in-hospital mortality and a composite of death, stroke, acute kidney injury (AKI), and major bleeding (MACE). (3) Results: Among 5745 patients, 405 (7.0%) met frailty criteria. Frail patients were older, with higher rates of chronic pulmonary disease, diabetes, and chronic kidney disease. There was no difference in in-hospital death (4.9% vs. 2.4%, <i>p</i> = 0.169); however, the frail group exhibited higher rates of stroke and AKI. Frail patients had a longer length of stay (17 vs. 8 days), and higher rates of non-home discharge (74.1% vs. 54.3%) than non-frail patients (both <i>p</i> < 0.001). Sensitivity analysis confirmed increased morbidity and mortality in frail individuals. After adjusting for patient comorbidities and hospital characteristics, frailty independently predicted MACE (OR 4.29 [1.88–9.78], <i>p</i> = 0.001), while age alone did not (OR 1.00 [0.99–1.02], <i>p</i> = 0.568). Urban teaching center status predicted a lower risk of MACE (OR 0.27 [0.08–0.94], <i>p</i> = 0.039). (4) Conclusions: Frailty is associated with increased morbidity in proximal aortic surgery and is a more significant predictor of mortality than age. Coordinated treatment in urban institutions may enhance outcomes for this high-risk group.https://www.mdpi.com/2308-3425/11/1/32aortic surgeryaortic aneurysmfrailty |
| spellingShingle | Edward D. Percy Thais Faggion Vinholo Paige Newell Supreet Singh Sameer Hirji Jake Awtry Robert Semco Muntasir Chowdhury Alexander K. Reed Sainath Asokan Alexandra Malarczyk Alexis Okoh Morgan Harloff Farhang Yazdchi Tsuyoshi Kaneko Ashraf A. Sabe The Impact of Frailty on Outcomes of Proximal Aortic Aneurysm Surgery: A Nationwide Analysis Journal of Cardiovascular Development and Disease aortic surgery aortic aneurysm frailty |
| title | The Impact of Frailty on Outcomes of Proximal Aortic Aneurysm Surgery: A Nationwide Analysis |
| title_full | The Impact of Frailty on Outcomes of Proximal Aortic Aneurysm Surgery: A Nationwide Analysis |
| title_fullStr | The Impact of Frailty on Outcomes of Proximal Aortic Aneurysm Surgery: A Nationwide Analysis |
| title_full_unstemmed | The Impact of Frailty on Outcomes of Proximal Aortic Aneurysm Surgery: A Nationwide Analysis |
| title_short | The Impact of Frailty on Outcomes of Proximal Aortic Aneurysm Surgery: A Nationwide Analysis |
| title_sort | impact of frailty on outcomes of proximal aortic aneurysm surgery a nationwide analysis |
| topic | aortic surgery aortic aneurysm frailty |
| url | https://www.mdpi.com/2308-3425/11/1/32 |
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