Prognostic Value of Hospital Frailty Risk Score and Clinical Outcomes in Patients Undergoing Revascularization for Critical Limb–Threatening Ischemia

Abstract

Background The impact of medical record‐based frailty assessment on clinical outcomes in patients undergoing revascularization for critical limb‐threatening ischemia (CLTI) is unknown. Methods and Results This study included patients with CLTI aged ≥18 years from the nationwide readmissions database 2016 to 2018 who underwent endovascular revascularization (ER) or surgical revascularization (SR). The hospital frailty risk score, a previously validated International Classification of Diseases, Tenth Edition, Clinical Modification (ICD‐10‐CM ) claims‐based score, was used to categorize patients into low‐ (<5), intermediate‐ (5–15), and high‐risk (>15) frailty categories. Primary outcomes were in‐hospital mortality and major amputation at 6 months. A total of 64 338 patients were identified who underwent ER (82.3%) or SR (17.7%) for CLTI. The mean (SD) age of the cohort was 69.3 (11.8) years, and 63% of patients were male. This study found a nonlinear association between hospital frailty risk score and in‐hospital mortality and 6‐month major amputation. In both ER and SR cohorts, the intermediate‐ and high‐risk groups were associated with a significantly higher risk of in‐hospital mortality (high‐risk group: ER: odds ratio [OR], 7.2 [95% CI, 4.4–11.6], P <0.001; SR: OR, 28.6 [95% CI, 3.4–237.6], P =0.002) and major amputation at 6 months (high‐risk group: ER: hazard ratio [HR], 1.6 [95% CI, 1.5–1.7], P <0.001; SR: HR, 1.7 [95% CI, 1.4–2.2], P <0.001) compared with the low‐risk group. Conclusions The hospital frailty risk score, generated from the medical record, can identify frailty and predict in‐hospital mortality and 6‐month major amputation in patients undergoing ER or SR for CLTI. Further studies are needed to assess if this score can be incorporated into clinical decision‐making in patients undergoing revascularization for CLTI.