This study aimed to evaluate the impact of frailty and inflammation on all-cause mortality in patients with abdominal aortic aneurysm (AAA) who underwent endovascular aneurysm repair (EVAR), and key risk factors were also explored.

A retrospective analysis was conducted on 174 patients with AAA who underwent EVAR at Beijing Hospital between 2016 and 2024. Frailty was assessed using the modified five-item Frailty Index (mFI-5). Inflammation was quantified by the red cell distribution width-to-albumin ratio (RAR), a novel inflammatory marker. We examined the associations between frailty, preoperative risk factors, and mortality using Kaplan-Meier survival analysis and Cox proportional hazards models. Mediation analysis was performed to evaluate the role of RAR in the relationship between frailty and mortality.

Frailty was found to be an independent risk factor for all-cause mortality following EVAR (HR = 1.95, P = 0.048). Preoperative anemia (HR = 0.98, P = 0.032), elevated creatinine levels (HR = 1.01, P = 0.013), and prolonged operation time (HR = 1.01, P = 0.029) were also independent predictors of mortality. Kaplan-Meier survival analysis revealed significantly lower survival rates for frailty patients (P = 0.004). Additionally, RAR mediated 23.8% of the relationship between frailty and mortality (P = 0.012), underscoring its role as a key indicator of chronic inflammation.

Frailty and chronic inflammation, as measured by the innovative RAR marker, are significant contributors to mortality after EVAR. This study highlights the clinical utility of RAR in identifying high-risk AAA patients and its potential for guiding targeted preoperative interventions. Incorporating frailty assessments and inflammation monitoring into routine preoperative evaluations may improve patient outcomes by enabling personalized approaches such as nutritional optimization and inflammation control.