Association between preoperative frailty and outcomes among adults undergoing cardiac surgery: a prospective cohort study

Abstract

F railty, defined as a state of exaggerated vulnerability to adverse health outcomes owing to the accumulation of age-related deficits, is increasingly recognized as an important factor associated with suboptimal outcomes for patients undergoing cardiac surgery. [1][2][3][4] Despite this association, there is no consistent screening strategy for frailty and limited incorporation of frailty-related functional measures into cardiac surgery risk scores or proven care pathways to mitigate the perioperative risk for vulnerable patients living with frailty.As the Canadian population ages, the incidence of frailty and concomitant cardiovascular disease prompting consideration for complex interventions are expected to grow. [5][6][7] Advances in intensive care and anesthetic and surgical techniques have improved outcomes, translating into older, more complex patients now routinely undergoing cardiac surgery. 5 Identifying patients with frailty before cardiac surgery may have relevance for prognostic and recovery purposes and support future improvement in care processes to better inform patients, caregivers, surgeons and decision-makers about preoperative opportunities (e.g., prehabilitation), perioperative risks, and short and longer-term postoperative care needs. The aim of this study was to estimate the prevalence of frailty and describe the associated clinical course and outcomes of patients referred for nonemergent cardiac surgery.

Does Preoperative Cognitive Optimization Improve Postoperative Outcomes in the Elderly?

“…Frailty syndrome is measured as the sum of various indicators, including unintentional weight loss, fatigue, muscle weakness, low physical activity, low gait speed, poor balance, visual impairment, and cognitive impairment [41,42]. The prevalence of preoperative frailty varies significantly (up to 50-60%) depending on age and the type of surgery, with a steep increase observed in older patients [43][44][45][46]. Preoperative frailty is known to be associated with poor postoperative morbidity and mortality [47].…”

Reproducibility and validity of the Portuguese Edmonton Frail Scale version in cardiac surgery patients

“…4 Different frailty screening tools have been used before cardiac surgery and showed to outperform the EuroSCORE and Society of Thoracic Surgery (STS) scores in mortality prediction. 5,6 It is currently accepted that frailty is associated with higher mortality in elderly people with cardiovascular disease and less functional survival in cardiac surgery patients. 5---7 However, the value of systematic frailty screening before surgery is not limited to better prognostic performance, it has also implications for adequate planning of care and clinical governance, especially if the tool in use enables the identification of vulnerability domains amenable to preoperative intervention and optimization.…”

Frailty assessment tools and associated postoperative outcomes in older patients undergoing elective surgery: A prospective pilot study

“…Frailty is a state of increased vulnerability to stressors due to reduced physiologic reserve across multiple organ systems 1–3 . It is associated with several unfavorable postoperative outcomes, including more than double the risk of short‐term mortality and surgical complications, and increased risk of prolonged hospital stay and unplanned readmission 4–8 . Evaluating frailty prior to surgery is essential to identify elderly patients at increased risk of adverse outcomes to tailor their perioperative course and offer prehabilitation 6,9,10 …”

“…[1][2][3] It is associated with several unfavorable postoperative outcomes, including more than double the risk of short-term mortality and surgical complications, and increased risk of prolonged hospital stay and unplanned readmission. [4][5][6][7][8] Evaluating frailty prior to surgery is essential to identify elderly patients at increased risk of adverse outcomes to tailor their perioperative course and offer prehabilitation. 6,9,10 The Comprehensive Geriatric Assessment is a multidisciplinary diagnostic assessment carried out by a geriatric team and has been considered by several studies to be the golden standard for frailty assessment.…”