The association of racial and ethnic disparities and frailty in geriatric patients undergoing revascularization for peripheral arterial disease

The aging population in the United States continues to grow and is expected to increase 35% in the coming decades [1,2]. Over the years, there has been a steady increase in the number of older adult patients requiring operative intervention [3]. Older adult patients routinely present with multiple chronic conditions with polypharmacy, along with physiological and functional impairments [4]. However, old age does not always equal adverse outcomes. Variability exists among older adult patients based on individual physiological reserve, which can be assessed by frailty.

Frailty has been an established tool for predicting postoperative outcomes across surgical specialties [4], [5], [6]. In patients undergoing vascular intervention, frail patients have been found to have higher morbidity, mortality, and even failure to rescue in comparison with nonfrail patients [6], [7], [8], [9]. Frailty syndrome is the amalgamation of intrinsic patient factors (such as age, sex, nutritional status, functional capacity, hormonal balance, and preexisting medical conditions) that results in increased morbidity and mortality after surgical intervention [1]. Social, economic, racial, and ethnic factors impact frailty, however, these disparities are not well understood.

Health disparities are well documented in the surgical literature, highlighting the differences in the quality of health care across racial, ethnic, sex, and demographic groups (biology or environment) [10,11]. Patients with peripheral arterial disease (PAD) progress to develop disabling symptoms of ischemia and functional loss. Chronic limb-threatening ischemia (CLTI) represents the end stage of lower extremity disease, which, if not treated adequately, leads to limb loss and increased morbidity and mortality. There have been multiple studies describing racial, ethnic, and sex disparities in PAD [8,11,12]. However, there is a paucity of data in the surgical literature regarding the role of frailty and disparities among patients undergoing surgical intervention. We aimed to assess whether race and ethnicity influences frailty status in geriatric patients undergoing revascularization for PAD with CLTI.

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