Impact of frailty on outcomes of patients undergoing elective endovascular thoraco-abdominal aortic aneurysm repair

BACKGROUND: Frailty and it score assessment by the Clinical Frailty Scale (CFS) have been recently proposed in surgery to overcome chronological age and major comorbidities as predictor tools of the surgical risks. We aim to evaluate the impact of frailty on outcomes of patients undergoing TAAA endovascular repair and whether CFS may be used as screening tool in the preoperative work-up and peri-operative risk stratification. METHODS: REtrospective analysis of 76 patients (61 male, 74.9±6.9 years) undergoing elective branched-EVAR. Patients were divided in Group A (CFS<5) and Group B (CFS>5). Post-operative morbidity, access-site related-complications, ICU- and in-hospital length-of-stay, reintervention rate, surgery- and all-causes related mortality were evaluated. RESULTS: Fifty-four patients (71.1%) were classified as CFS<5, whereas twenty-two as CFS>5. Demographics and comorbidities were homogeneous regardless of CFS class. No differences in term of MAE and of access-site related-complication but a greater perioperative and early mortality rate in the group of frail patients was noted (P=0.009, OR 11.8, 95% CI 1.35-3.58; P=0.019, respectively), as a longer hospitalization (P=0.007) and more frequent non-home discharge. Mid-term aneurysm- and all-causes related mortality was similar in both groups. CONCLUSIONS: Frailty seems to be associated with worse perioperative outcomes. CFS is a reliable tool to quantify the degree of disability due to frailty and to better assess the risks and benefits of endovascular TAAA repair. Frailty is not equated with inoperability but indicate the need for a tailored approach for the more vulnerable patients. Larger studies and a widespread use of frailty screening methods are needed to confirm its efficacy in the prediction of outcomes after endovascular interventions.