Unmasking frailty in coronary artery disease:impact on out-comes after lower limb amputation
Abdul Rasheed Bahar
Yasemin Bahar
Busra Cangut
Paawanjot Kaur
Vaishnavi Sire-kulam
Mohamad Hasan Jawadi
Naveed Tarar
Mohamed Saleh Alrayyashi
Olayiwola Bolaji
M.Chadi Alraies
Abstract：Background Frailty is a major determinant of outcomes in patients with coronary artery disease (CAD) undergoing lower limb amputation. This study evaluates the impact of frailty on in-hospital outcomes in these patients.
Methods We performed a retrospective analysis of the National Inpatient Sample (2016-2021) to identify adult patients with CAD who underwent lower limb amputation. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty indicator. Multivariable logistic regression was used to assess the independent association of frailty with in-hospital outcomes, and propensity score matching (PSM) was performed to further account for confounding factors.
Results After PSM, 9,990 patients were included in each cohort. Frail patients experienced higher rates of in-hospital mortality (3.9% vs. 1.5%, P < 0.001), acute limb ischemia (3.8% vs. 3.1%, P = 0.015), fasciotomy (2.1% vs. 1.4%, P < 0.001), stump infection (7.9% vs. 6.6%, P < 0.001), cardiogenic shock (0.9% vs. 0.7%, P = 0.032), sudden cardiac arrest (2.7% vs. 2.1%, P = 0.004), mechanical circulatory support (0.3% vs. 0.2%, P = 0.028), major adverse cardiac and cerebrovascular events (7.7% vs. 5.4%, P < 0.001), and sepsis (18.3% vs. 13.8%, P < 0.001). In multivariable logistic regression analysis, frailty remained an independent predictor of in-hospital mortality and major complications.
Conclusion Frailty is independently associated with increased in-hospital mortality and adverse events among CAD patients undergoing lower limb amputation. Incorporating frailty assessment into preoperative evaluation may improve risk stratification and guide clinical decision-making in this high-risk population.
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Publication Date：2025-11-30
Online Publishing Date：2026-01-09(First online date of this platform, not the publication date of the document)
Pages：11( 900-910 )