(IP057) Factors associated with one-year functional decline after elective endovascular abdominal aortic aneurysm repair in octogenarians

Objectives: Frailty can be used to estimate perioperative and long-term mortality risk in octogenarians undergoing elective endovascular abdominal aortic aneurysm repair (EVAR). However, its association with long-term functional status, an important surrogate of quality of life for patients of advanced age, is not well studied. We aimed to identify whether certain factors such as frailty were associated with one-year functional decline after elective EVAR in octogenarians.

Methods: The Vascular Quality Initiative (VQI) database was queried for octogenarians who underwent elective EVAR for an asymptomatic infrarenal abdominal aortic aneurysm (AAA) (August 2014 to June 2023). Functional status was measured using Eastern Cooperative Oncology Group (ECOG) performance status (0-1: independent; 2-4: impaired). Octogenarians who were functionally independent preoperatively and completed one-year follow-up between nine and fifteen months were included. The primary outcome was functional decline, defined as a change to impaired status at follow-up. The cohort was randomly divided 3:1 into development and validation cohorts. In the development cohort, clinical characteristics were compared between patients with and without decline. Backward stepwise logistic regression generated a parsimonious model that was evaluated using C-statistic and Hosmer-Lemeshow goodness-of-fit tests.

Results: Among 13,645 octogenarians, 75.6% (n=10,327) were functionally independent preoperatively. One-year mortality was 9.1%. 50.4% of survivors completed one-year follow-up within the allotted timeframe (n=3,561). Functional decline occurred in 18.3% (n=490) of the development cohort (n=2,670), with 19% (n=94) requiring assisted care. In the development cohort, octogenarians with decline were more likely to be older (85 vs 84 years), had more preoperative comorbidities including chronic obstructive pulmonary disease (31% vs 26%) and congestive heart failure (17% vs 13%), and experienced fewer home discharges (91% vs 96%) (p < 0.05). On multivariable analysis, increased risk of decline was associated with age (OR: 1.10; CI: 1.07-1.14), higher ECOG status (OR: 2.14; CI: 1.75-2.62), and VQI-Frailty Score (OR: 2.98; CI: 1.27-6.98). The 3-item model predicted one-year functional decline with acceptable discrimination (C-statistic: 0.66) and good calibration (Hosmer-Lemeshow p>0.05) in the validation cohort (Table II).

Conclusions: Functional decline was not uncommon among octogenarians one year after elective EVAR, though estimates relied on limited measures and follow-up data. Frailty was a strong risk factor for decline and may help identify octogenarians for prehabilitation. Our study underscores the importance of frailty screening in AAA care not only for the assessment of perioperative outcomes but also for the projection of functional status.