Enhanced Recovery Protocols Reduce Length of Stay in Frail Bypass Patients

Frailty is a primary determinant of surgical outcomes in peripheral arterial disease, with a pooled prevalence of 49% (95% CI 37-61%) among this patient population [1]. In the context of chronic limb-threatening ischemia (the advanced stage of peripheral arterial disease characterized by ischemic rest pain, ulceration, or gangrene), frailty is associated with a significant increase in mortality, carrying an odds ratio of 2.25 [2, 3]. Beyond survival, these vulnerable patients face a high risk of functional decline, including a loss of independent mobility and a greater likelihood of discharge to skilled nursing facilities or other higher levels of care [4]. While addressing modifiable risk factors is necessary to improve amputation-free survival (a composite clinical endpoint measuring the time a patient lives without requiring a major limb amputation), the efficacy of standardized perioperative recovery protocols in this specific cohort requires further investigation [5]. To address this gap, researchers recently evaluated whether structured enhanced recovery protocols can be effectively implemented in highly frail patients to reduce adverse outcomes following lower extremity bypass surgery.