Unmasking frailty in coronary artery disease: impact on outcomes after lower limb amputation

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.

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.

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.

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.