Scripties UMCG - Rijksuniversiteit Groningen
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Frailty changes over time in vascular surgery patients

(2017) Banning, L.B.D. (Wiesje)

Rationale: Frailty is a clinical geriatric syndrome which is frequently used to describe the
most vulnerable or weakest older adults. Previous studies have shown that frailty in the
vascular surgical ward is common and predicts poor surgical outcome after different vascular
surgery interventions. To determine the effect of the vascular surgery intervention on the
frailty state of the patient, the change in frailty state of the patient after the surgery should be
Objective: To determine that frailty is a dynamic process within vascular surgery patients and
that it can be influenced by the surgical intervention.
Patients and methods: Between 2014 and 2017, 268 consecutive patients scheduled for
vascular surgery at the University Medical Center Groningen were included in this cohort
study. From all patients the change in frailty state between the index measurement (prior to
surgery) and the measurement during follow-up was determined. The frailty scores has been
measured using the Groningen Frailty Indicator (GFI), a validated and widely used tool to
measure frailty. Further, specific changes in the different domains of the GFI and the patient
characteristics leading to a change in frailty has been analyzed. All statistical analyses have
been performed with the Statistical Package for the Social Sciences (IBM© SPSS Statistics©
Version 23).
Main study parameters/endpoints: The primary outcome is the change in total frailty score
between the index measurement and the measurement during the follow-up. Following, the
individual domains are compared to determine which domain has the most impact on this
Results: A total of 268 patients were included, the mean age (± SD) was 72.7 ± 5.2 years,
75% were male and the mean BMI was 27.0 ± 4.7. The mean follow-up time was 23.7 ± 9.6
months. During follow-up, 33.2% of the patients were readmitted to the hospital ≥ 1 and
22.4% required redo surgery. A total of 128 patients (47.8%) became more frail, 64 patients
(23.9%) stayed equally frail and 76 patients (27.9%) became less frail during the follow-up.
The patients with an increase in frailty state had a higher BMI (27.5 kg/m²) (p=0.015) and
more hospital readmissions (p-value=0.027). The GFI domains “hearing”, “psychosocial” and
“physical fitness” contributed most to worsening in frailty state. Respectively 35.4%, 61.4%
and 38.4% of the patients with a worsening in frailty state had a higher score in those domains
after follow-up.
Conclusion: Almost 50% of the patients show an increase in frailty during follow-up
compared to the preoperative measurement. This increase already occurs in the first year after
the surgery and then it stabilizes. A higher BMI and hospital readmissions contribute to this
change in frailty state. These study results could potentially be used to predict the impact of
vascular surgery on the course of frailty after surgery.

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