The current coronavirus disease 2019 (COVID-19) pandemic has highlighted the vulnerability of older, frail patients in our healthcare systems. Older patients requiring vascular surgery are at significant risk of adverse outcomes due to higher rates of multimorbidity, frailty and disease severity. Our findings highlight that older, frail patients, experience potentially preventable adverse outcomes and there is a need for targeted interventions to optimize care, especially in times of healthcare stress. At 6 months, frail patients had twice the odds of major amputation compared to non-frail patients, after adjustment (OR 2.01 95% CI 1.17–3.78), driven by a high rate of amputation during the period of reduced surgical activity. However, frail patients stayed longer in hospital, had more perioperative complications, and were more likely to be readmitted or have a reoperation when compared to non-frail patients. The 30 day and 6 month mortality was 2.0% ( n = 20) and 5.9% ( n = 35) respectively with no significant difference between frail and non-frail patients (OR 1.68, 95%CI 0.79–3.54). Of the 917 patients enrolled, 203 were frail (22.1%). Frailty was assessed using the nine-point visual Clinical Frailty Score, scores of 5 or more considered frail. The primary outcome was mortality, with secondary outcomes procedure-related outcomes and hospital utilization. The COVID-19 Vascular Service in Australia (COVER-AU) prospective cohort study evaluates 30-day and six-month outcomes for consecutive patients having vascular surgery in 11 Australian vascular units, March–July 2020. This cohort study describes the prevalence of frailty in patients having vascular surgery and the association between frailty, mortality and perioperative outcomes. Frailty assessment is a potential tool to inform resource allocation, and shared decision-making about vascular surgery in the resource constrained COVID-19 pandemic environment. Frailty predicts adverse perioperative outcomes and increased mortality in patients having vascular surgery.
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