Prognostic effect of the new 5-factor modified frailty index in patients undergoing carotid endarterectomy with regional anesthesia - A prospective cohort study

Background: Frailty has been studied as a valuable predictor of adverse health events and poor postoperative outcomes in patients undergoing surgery. Thus, the use of simple and adapted indexes to define frailty, like the modified frailty index (mFI)-11, proved useful in assessing patients undergoing vascular surgery. However, the literature about the applicability of an even more pragmatic index, the modified frailty (mFI) index mFI-5 in vascular patients is scarce, particularly in those submitted to carotid endarterectomy (CEA). This study aimed to validate and estimate the prognostic value of the mFI-5 on the postoperative period and long-term survival of this population. Methods: From January 2011 to June 2019, 184 patients from a tertiary care referral center who underwent CEA with regional anesthesia for carotid artery stenosis were selected from a previous prospectively mantained cohort database. Clinical adverse events such as stroke, myocardial infarction (MI), acute heart failure (AHF), and all-cause mortality were assessed 30-days post-procedure and in the subsequent long-term surveillance period. mFI-5 was applied to this population to evaluate the impact of frailty on mortality and morbidity. Results: The mFI-5 was significantly associated with increased risk of long-term MI (P < 0.001), AHF (P = 0.043), major adverse cardiovascular events (P = 0.001) and mortality (P < 0.001). Concerning major adverse limb events and stroke survival, mFI-5 did not reveal statistical significance. The mFI-5 was not able to predict 30-day postoperative adverse events. Conclusion: The mFI-5 has demonstrated to be a potential index tool capable of easily stratifying patients and predicting outcomes in the long-term and add therapeutic value in the future. The mFI-5 provides a means of rapidly comparing the comorbidity charge between cohorts.