Direct comparison of frailty scores and their association with postoperative outcomes in patients undergoing lower extremity revascularization.

Abstract

Frailty is increasingly recognized as a key driver of postoperative risk in vascular surgery. Yet the relative accuracy of the major frailty indices in a purely vascular cohort remains unclear. We compared the predictive accuracy of the Modified Frailty Index, Risk Analysis Index, Vascular Quality Initiative Frailty Index (VQI-FI), and VQI Procedure-Based Index (VQI-PBI) in predicting adverse postoperative outcomes in patients undergoing lower extremity revascularization. In this retrospective single-center cohort study, 182 patients who underwent open or endovascular lower extremity revascularization between January 1 and December 31, 2023, were included. Frailty scores were calculated retrospectively based on data available at the time of the preoperative evaluation. Primary outcomes were 30-day and 1-year mortality and 30- and 60-day hospital readmissions. Secondary outcomes included new dialysis within 30 days, and myocardial infarction. Statistical associations were evaluated using logistic regression models. The cohort's mean age was 69.4 years, 32% were female, and 74% presented with critical limb ischemia. All four indices predicted 1-year mortality and initiation of dialysis within 30 days. The Modified Frailty Index, VQI-FI, and VQI-PBI also predicted 30-day readmission, but only the VQI scores were associated with 60-day readmission. The Risk Analysis Index was the only score associated with in-hospital mortality. The VQI-FI demonstrated the greatest number of statistical associations with good discriminatory ability. Vascular-specific frailty indices (VQI-FI and VQI-PBI) provide superior risk stratification compared with generic measures. Incorporating these tools into preoperative evaluation may improve patient selection and shared decision-making.