{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:03:18Z","timestamp":1792105398810,"version":"4.4.0"},"reference-count":36,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,1,20]],"date-time":"2024-01-20T00:00:00Z","timestamp":1705708800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of British Columbia Clinician Investigator Program, and the Bulens family"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>(1) Background: This study examines frailty\u2019s impact on proximal aortic surgery outcomes. (2) Methods: All patients with a thoracic aortic aneurysm who underwent aortic root, ascending aorta, or arch surgery from the 2016\u20132017 National Inpatient Sample were included. Frailty was defined by the Adjusted Clinical Groups Frailty Indicator. Outcomes of interest included in-hospital mortality and a composite of death, stroke, acute kidney injury (AKI), and major bleeding (MACE). (3) Results: Among 5745 patients, 405 (7.0%) met frailty criteria. Frail patients were older, with higher rates of chronic pulmonary disease, diabetes, and chronic kidney disease. There was no difference in in-hospital death (4.9% vs. 2.4%, p = 0.169); however, the frail group exhibited higher rates of stroke and AKI. Frail patients had a longer length of stay (17 vs. 8 days), and higher rates of non-home discharge (74.1% vs. 54.3%) than non-frail patients (both p &lt; 0.001). Sensitivity analysis confirmed increased morbidity and mortality in frail individuals. After adjusting for patient comorbidities and hospital characteristics, frailty independently predicted MACE (OR 4.29 [1.88\u20139.78], p = 0.001), while age alone did not (OR 1.00 [0.99\u20131.02], p = 0.568). Urban teaching center status predicted a lower risk of MACE (OR 0.27 [0.08\u20130.94], p = 0.039). (4) Conclusions: Frailty is associated with increased morbidity in proximal aortic surgery and is a more significant predictor of mortality than age. Coordinated treatment in urban institutions may enhance outcomes for this high-risk group.<\/jats:p>","DOI":"10.3390\/jcdd11010032","type":"journal-article","created":{"date-parts":[[2024,1,22]],"date-time":"2024-01-22T05:42:31Z","timestamp":1705902151000},"page":"32","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The Impact of Frailty on Outcomes of Proximal Aortic Aneurysm Surgery: A Nationwide Analysis"],"prefix":"10.3390","volume":"11","author":[{"given":"Edward D.","family":"Percy","sequence":"first","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA 02115, USA"},{"name":"Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9572-6861","authenticated-orcid":false,"given":"Thais","family":"Faggion Vinholo","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA 02115, USA"},{"name":"Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paige","family":"Newell","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8808-3653","authenticated-orcid":false,"given":"Supreet","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mount Sinai Hospital, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5032-675X","authenticated-orcid":false,"given":"Sameer","family":"Hirji","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jake","family":"Awtry","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Semco","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muntasir","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Trinity Health System, Steubenville, OH 43952, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5235-9483","authenticated-orcid":false,"given":"Alexander K.","family":"Reed","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8474-1601","authenticated-orcid":false,"given":"Sainath","family":"Asokan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, St. Christopher\u2019s Hospital for Children, Philadelphia, PA 19134, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Malarczyk","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Okoh","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan","family":"Harloff","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhang","family":"Yazdchi","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuyoshi","family":"Kaneko","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University in St Louis, St. Louis, MO 63110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf A.","family":"Sabe","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cger.2010.08.009","article-title":"The frailty syndrome: Definition and natural history","volume":"27","author":"Xue","year":"2011","journal-title":"Clin. 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