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UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients DISCLOSURES INDIVIDUAL FRAILTY AND

  1. UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients DISCLOSURES � INDIVIDUAL FRAILTY AND COGNITION None IN THE ASSESSMENT OF � INSTITUTIONAL Cook, Inc VASCULAR SUGERY PATIENTS � Not discussing off-label use of anything UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients WHY WHY � Frailty increases with age � Frailty increases with age Etzioni et al, Ann Surg, 2003 1

  2. UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients WHY DEFINITION � Frailty increases with age Fried Frailty Phenotype � Unintentional weight loss � Self-reported exhaustion � Weakness (grip strength) � Slow walking speed � Low physical activity Fried et al, J Gerontology, 2001 Etzioni et al, Ann Surg, 2003 UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients WHAT IS FRAILTY WHAT IS FRAILTY 2

  3. UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients WHAT IS FRAILTY WHAT IS FRAILTY Revenig et al, J Surg Res 2015 Hii et al, Heart, Lung and Circulation, 2014 UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients DEFINITION FRAILTY ASSESSMENT � Decreased physiologic reserve and resistance Single variables Multi-dimensional Scales to stressors � Psoas muscle mass � Medical co-morbidities � Disruption of homeostatic mechanisms leading (sarcopenia) • Medication number to a vulnerable state � Walking speed • nutrition � Increased vulnerability to stressors as a result � Grip strength � Mental health of decreased physiological reserve � Time to up and go (TUAG) • Cognition • Mood � Functional status • Dependence / independence � Social circumstances � Environment 3

  4. UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients SCALES SCALES � Fried frailty phenotype Fried Frailty Phenotype � Rockwood Canadian Study of Health � Unintentional weight loss and Aging (CSHA) Frailty Index � Self-reported exhaustion � Edmonton Frail Scale � Weakness (grip strength) � modified Frailty Index � Slow walking speed � Comprehensive Assessment of Frailty � Low physical activity � Groningen Frailty Indicator � Tilburgh Frailty Indicator � FRAIL Scale � Comprehensive Geriatric Assessment Jung et al, J Thorac Cardiovasc Surg, 2014 UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients SCALES SCALES Rockwood—Canadian Study of Health and Aging (CSHA) SURVIVAL Frailty Index Fried Frailty Phenotype � Unintentional weight loss � Self-reported exhaustion � Weakness (grip strength) � Slow walking speed � Low physical activity Fried et al, J Gerontology, 2001 Rockwood K et al, CMAJ, 2005 4

  5. UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients SCALES SCALES Rockwood—Canadian Study of Health and Aging (CSHA) Rockwood—Canadian Study of Health and Aging (CSHA) Frailty Index Frailty Index Rockwood K et al, CMAJ, 2005 UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients SCALES SCALES Edmonton Frail Scale Edmonton Frail Scale Rolfson et al, Age Ageing, 2006 Rolfson et al, Age Ageing, 2006 5

  6. UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients SCALES SCALES modified Frailty Index modified Frailty Index Beggs et al, Can J Anesth, 2015 Arya et al, J Vasc Surg, 2015 Karam et al, Ann Vasc Surg, 2013 Melin et al, J Vasc Surg, 2015 UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients SCALES FRAILTY AND VASCULAR SURGERY Comprehensive Assessment of Frailty OUTCOMES Psoas Muscle Mass General & Vascular Procedures Englesbe et al, Ann Surg, 2012 Beggs et al, Can J Anesth, 2015 6

  7. UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients FRAILTY AND VASCULAR SURGERY FRAILTY AND VASCULAR SURGERY OUTCOMES OUTCOMES Addenbrooke Vascular Frailty Score Psoas Muscle Mass All Vascular AAA Repair Procedures Ambler et al Lee et al, J Vasc Surg, 2011 Brit J Surg, 2015 UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients FRAILTY AND VASCULAR SURGERY FRAILTY AND VASCULAR SURGERY OUTCOMES OUTCOMES Addenbrooke Vascular Frailty Score Addenbrooke Vascular Frailty Score Overall Survival Readmission – Free Survival All Vascular All Vascular Procedures Procedures Ambler et al Brit J Surg, 2015 Ambler et al, Brit J Surg, 2015 7

  8. UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients FRAILTY AND VASCULAR SURGERY FRAILTY AND VASCULAR SURGERY OUTCOMES OUTCOMES Canadian Study of Health and Aging Frailty Index Canadian Study of Health and Aging Frailty Index All Vascular Procedures All Vascular Procedures Karam et al, Ann Vasc Surg, 2013 Karam et al, Ann Vasc Surg, 2013 UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients FRAILTY AND VASCULAR SURGERY FRAILTY AND VASCULAR SURGERY OUTCOMES OUTCOMES Risk Analysis Index Matched to NSQIP Variables (mFI) Risk Analysis Index Matched to NSQIP Variables (mFI) Carotid Carotid Endarterectomy Endarterectomy Melin et al, J Vasc Surg, 2015 Melin et al, J Vasc Surg, 2015 8

  9. UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients FRAILTY AND VASCULAR SURGERY FRAILTY AND VASCULAR SURGERY OUTCOMES OUTCOMES Functional Health Status (NSQIP) Functional Health Status (NSQIP) General & All Vascular Vascular Scarborough et al, Ann Surg, 2015 Scarborough et al, Ann Surg, 2015 UCSF Vascular & Endovascular Symposium 2015 UCSF Vascular & Endovascular Symposium 2015 UC SF UC SF Frailty in Vascular Surgery Patients Frailty in Vascular Surgery Patients FRAILTY AND VASCULAR SURGERY IMPAIRED COGNITION OUTCOMES Impaired cognition in vascular patients Modified Frailty Index (NSQIP) � 68% � 88% unrecognized � 60% of the study group previously not known to have cognition issue Velanovich et al, J Surg Res, 2013 Partridge et al, J Vasc Surg, 2014 9

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