LAUSR

OBJECTIVES Frailty is associated with adverse outcomes among patients with vascular disease. Grip strength measurement is a comparatively simple, quick, and inexpensive screening test for weakness (a component of frailty) that is potentially applicable to clinical practice. We hypothesized that grip strength and categorical weakness are associated with clinical outcomes among patients with vascular disease. To test this hypothesis, we conducted a longitudinal cohort study evaluating associations between grip strength measured during outpatient clinic visits for vascular disease and clinical outcomes, including survival and perioperative outcomes. METHODS Adult patients recruited from an outpatient Vascular Surgery and/or Vascular Medicine clinics underwent dominant hand grip strength measurement using a hand dynamometer. Participants were categorized as weak based on grip strength, gender, and body mass index. Multivariable logistic models were used to evaluate peri-operative outcomes. Mortality was evaluated using Cox proportional hazards models adjusted for sex, age, and operative intervention during follow up. RESULTS 321 participants were enrolled. Mean age was 69.0 ± 9.4 years, and 33% were women. Mean grip strength was 32.0 ± 12.1 kg, and 92 participants (29%) were categorized as weak. Median follow up was 24.0 months. Adverse perioperative events occurred in 32/84 patients undergoing procedures. Grip strength was associated with decreased risk of perioperative adverse events (HR 0.41 per 12.7 kg increase; 95% CI 0.20-0.85; P=0.0171) in a model adjusted for open versus endovascular procedure (HR=12.75 for open; 95% CI 2.54-63.90; P=0.0020) and sex (HR=3.05 for male; 95% CI 0.75-12.4; P=0.120). Grip strength was also associated with lower risk of non-home discharge (HR 0.34 per 12.7 kg increase; 95% CI 0.14-0.82; P=0.016) adjusted for sex (HR 2.14 for male; 95% CI 0.48-9.50; P=0.31) and open versus endovascular procedure (HR 10.36 for open; 95% CI 1.20-89.47; P=0.034). No associations between grip strength and length of stay were observed. Mortality occurred in 48 participants (14.9%) during follow-up. Grip strength was inversely associated with mortality (HR 0.46 per 12.5 kg increase; 95% CI 0.29-0.73; P=0.0009) in a model adjusted for sex (HR 5.08 for male; 95% CI 2.1-12.3; P=0.0003), age (HR 1.04 per year; 95% CI 1.01-1.08), and operative intervention during follow-up (HR 1.23; 95% CI 0.71-2.52). Categorical weakness was also associated with mortality (HR 1.81 versus non-frail; P=0.048) in a model adjusted for age (HR 1.06 per year; P=0.002) and surgical intervention (HR 1.36; 95% CI 1.02-0.09; P=0.331). CONCLUSIONS Grip strength is associated with all-cause mortality, perioperative adverse events, and non-home discharge among patients among patients with vascular disease. These observations support the utility of grip strength as a simple and inexpensive risk screening tool for patients with vascular disease.