Association of Age and Frailty with the Development of Adverse Events Following Carotid Endarterectomy in Asymptomatic Patients.

BACKGROUND

As carotid endarterectomy (CEA) is increasingly used for older adults, identification of risk factors in this cohort is critical. Frailty is increasingly recognized as a significant predictor of adverse surgical outcomes, yet contemporary associations with CEA outcomes in asymptomatic patients remain underexplored on a national scale.

METHODS

All adults (aged ≥18 years) with asymptomatic carotid artery stenosis undergoing elective CEA were identified from the 2013-2022 National Surgical Quality Improvement Program Participant Use Files. Frailty was defined using the validated 5-factor modified frailty index (dependent functional status, diabetes, hypertension, chronic obstructive pulmonary disease, congestive heart failure), with patients scoring ≥2 classified as Frail (others: nonFrail). Multivariable logistic regression models examined associations of age and frailty status with major adverse events (MAEs: death, stroke, or myocardial infarction) within 30 days, prolonged length of stay (≥2 postoperative days), nonhome discharge, and unplanned readmission within 30 days.

RESULTS

Of 18,887 CEA patients, 7,207 (38.2%) were Frail. Frail patients demonstrated increased MAE rates (3.5% vs. 1.9%, P < 0.001) and greater resource use. After adjustment, frailty was linked with increased odds of MAE (adjusted odds ratio [AOR] 1.60, 95% confidence interval [CI] 1.29-1.98), prolonged length of stay (AOR 1.31, CI 1.21-1.41), nonhome discharge (AOR 1.83, CI 1.40-2.39), and unplanned readmission (AOR 1.64, CI 1.41-1.92). Following marginal analysis of age and frailty, frailty remained associated with a higher risk-adjusted probability of MAEs.

CONCLUSION

Irrespective of age, frail patients exhibited concerning rates of MAEs. If future studies confirm these findings, prophylactic CEA in this vulnerable population should be carefully reconsidered.