Prognostic Value of Frailty and Other Risk Factors in Patients Undergoing Lower Limb Revascularisation or Primary Major Lower Limb Amputation

Objectives Patients requiring revascularisation are increasingly becoming older, more comorbid, and deconditioned. Frailty is associated with adverse outcomes, but its role in patients undergoing revascularisation remains underexplored. The study aimed to examine the role of frailty in amputation rates, amputation-free survival and all-cause mortality. Method Patients aged ≥ 18years in a tertiary centre in the United Kingdom, who underwent open revascularisation, and primary amputation between September 2022 and May 2024. Electronic clinical records till January 2025 were reviewed, collated and analysed. Frailty was assessed preoperatively by anaesthetists using the Rockwood Clinical Frailty Scale (CFS), and a score was assigned Results Four hundred and seven patients underwent revascularisation, and 89 had primary amputation. In the revascularisation group, 55 deaths (13.5%) and 46 (11.3%) major amputations occurred. CFS ≥ 6 was present in 116 (29%) patients who underwent revascularisation and independently predicted both amputation (HR 3.13, 95% CI 1.62-6.06, p<0.001) and all-cause mortality (HR 1.27, 95% CI 1.04-1.55, p=0.017). Diabetes also increased amputation risk (HR 2.93, 95% CI 1.51-5.67, p=0.001). In the primary amputation group, mortality was associated with age and diabetes, but not with frailty. However, patients with CFS ≥ 6 died earlier (p < 0.023). Conclusion Frailty plays an important role in predicting outcomes. Patients with higher frailty scores were significantly more likely to experience major amputation or death, particularly within the first year after their procedure. This early postoperative period appears to be a key window, during which frail patients may benefit from closer monitoring and support.