Frailty and Short Term Functional Outcomes following Abdominal Aortic Aneurysm Repair in Elderly Patients: A Prospective Cohort Study.

Abstract

Despite the growing number of vascular interventions performed in elderly patients, the functional outcomes regarding frailty remain unclear. This study aimed to evaluate and compare the short term functional outcomes in pre-operative frail vs. non-frail patients following open vs. endovascular abdominal aortic aneurysm (AAA) repair. Patients aged ≥ 65 years treated with elective open or endovascular AAA repair were included. They underwent the Groningen Frailty Indicator, Montreal Cognitive Assessment (MoCA), four metre walk test (4MWT), and handgrip strength (HGS) at three time points: pre-operatively and one and six months post-operatively. Linear mixed effect models were fitted to assess the effect of patient characteristics on the Groningen Frailty Indicator, MoCA, 4MWT, and HGS. Analyses were adjusted for age, sex, comorbidity, American Society of Anesthesiologists classification, and corresponding baseline test scores. A minimum sample size of 80 patients was calculated. All functional assessments were completed by 85 patients. The mean age was 74.2 years, 37 patients (39%) were frail at baseline, and 65 patients (68%) were treated with endovascular repair. Frail patients showed greater improvement in frailty scores than non-frail patients (β = -0.21 per month, p < .001). Patients treated with endovascular repair deteriorated more in frailty scores than those treated with open repair (β = 0.21 per month, p = .001). Overall, patients improved in MoCA score (β = 0.23, p = .011). Neither type of intervention nor frailty status were statistically significantly associated with changes in gait speed (β = 0.10 per month, p = .19; β = 0.07 per month, p = .29, respectively) or HGS (β = -0.11 per month, p = .35; β = -0.21 per month, p = .92, respectively). This study demonstrated that frailty is not necessarily associated with worse functional outcomes following open or endovascular AAA repair.