Frailty and perioperative patient-reported disability in patients undergoing cardiac surgery: a pilot study

Milne, Benjamin; Carvalho, Joshua Lucas de; Ayis, Salma; Chaubey, Sanjay; Khan, Habib; Kunst, Gudrun

doi:10.1016/j.bja.2022.03.015

Cited by 10 publications

(9 citation statements)

References 41 publications

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Section: Discussionsupporting

confidence: 92%

“…Previous studies have shown that the presence of preoperative frailty contributes to poor functional recovery, as assessed by the World Health Organization Disability Assessment Schedule 2.0 after cardiac and non-cardiac surgery. 7,8 In the present study, the odds ratio of the FFPQ score to disability-free survival was 0.66 (95% confidence interval 0.49-0.90), which is consistent with the findings of these studies. However, the frailty score was converted from a continuous variable to a dichotomous variable (robust and frail) in both studies, 7,8 and dichotomizing continuous variables led to several problems, including the reduction of statistical power and difficulty in determining an optimal cut-off point.…”

Section: Pvaluesupporting

confidence: 92%

“…In the present study, the odds ratio of the FFPQ score to disability‐free survival was 0.66 (95% confidence interval 0.49–0.90), which is consistent with the findings of these studies. However, the frailty score was converted from a continuous variable to a dichotomous variable (robust and frail) in both studies, 7,8 and dichotomizing continuous variables led to several problems, including the reduction of statistical power and difficulty in determining an optimal cut‐off point 20 . Furthermore, frailty is best used as a graded condition; the higher the level of frailty, the greater the vulnerability and the higher the risk of adverse outcomes 21 .…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] Frailty is a condition characterized by decreased reserves and reduced resistance to stressors, such as surgery, resulting in an increased risk of adverse outcomes, including postoperative functional disability and mortality. [6][7][8] Two conceptual frameworks have been used to assess frailty: the phenotype and accumulating deficit models. The use of the phenotype model is limited in routine clinical practice, as it requires the measurement of gait speed and handgrip strength.…”

Section: Introductionmentioning

confidence: 99%

“…Frailty is a condition characterized by decreased reserves and reduced resistance to stressors, such as surgery, resulting in an increased risk of adverse outcomes, including postoperative functional disability and mortality 6–8 . Two conceptual frameworks have been used to assess frailty: the phenotype and accumulating deficit models.…”

Section: Introductionmentioning

confidence: 99%

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Fried Frailty Phenotype Questionnaire scores and postoperative patient‐reported outcomes of patients undergoing major abdominal cancer surgery: A secondary analysis

Kinugasa,

Ida,

Kawaguchi

2024

Geriatrics Gerontology Int

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AimThis study aimed to evaluate the effects of Fried Frailty Phenotype Questionnaire (FFPQ) scores on patient‐reported postoperative outcomes.MethodsThis secondary analysis of a prospective observational study included 230 inpatients aged ≥65 years undergoing elective abdominal cancer surgery. The primary outcome was the Quality of Recovery‐15 score on postoperative days 2, 4 and 7. The secondary outcomes included disability‐free survival, defined as a 12‐item World Health Organization Disability Assessment Schedule 2.0 score of <16% at 3 months. The associations of the FFPQ scores, ranging from 0 (robust) to 5 (frailty), with the primary and secondary outcomes were assessed using multiple analysis.ResultsAfter confirming the linearity of the FFPQ score for the outcomes, multiple regression analysis adjusted for prominent factors showed that the FFPQ score was a significant factor influencing the decrease in the Quality of Recovery‐15 score on postoperative day 2 (β = −2.67, 95% confidence interval −5.20, −0.15), 4 (β = −3.54, 95% confidence interval −5.77, −1.30) and 7 (β = −3.70, 95% confidence interval −5.75, −1.65). The adjusted odds ratio of the FFPQ score for disability‐free survival postoperatively was 0.66 (95% confidence interval 0.49–0.90).ConclusionsPatients with higher FFPQ scores before elective major abdominal cancer surgery were likely to have lower postoperative Quality of Recovery‐15 scores and poor disability‐free survival. Geriatr Gerontol Int 2024; ••: ••–••.

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Section: Discussionsupporting

confidence: 92%

Section: Pvaluesupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fried Frailty Phenotype Questionnaire scores and postoperative patient‐reported outcomes of patients undergoing major abdominal cancer surgery: A secondary analysis

Kinugasa,

Ida,

Kawaguchi

2024

Geriatrics Gerontology Int

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Comparison between the effects of epidural and intravenous patient‐controlled analgesia on postoperative disability‐free survival in patients undergoing thoracic and abdominal surgery: A post hoc analysis

Hirai,

Ida,

Naito

et al. 2024

European Journal of Pain

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BackgroundThoracic epidural analgesia (TEA) and intravenous patient‐controlled analgesia (IV‐PCA) are widely used to mitigate immediate postoperative pain; however, their effects on long‐term disability‐free survival are poorly documented. This study aimed to compare the effects of postoperative TEA and IV‐PCA on disability‐free survival in patients who underwent thoracic or abdominal surgery.MethodsThis post hoc analysis of a prospective observational study included 845 inpatients aged ≥55 years that underwent elective thoracic and abdominal surgery between 1 April 2016 and 28 December 2018 in a tertiary care hospital. Inverse probability of treatment weighted (IPTW) using stabilized inverse propensity scores was adopted to minimize bias. The primary outcome in this study was disability‐free survival, defined as survival with a 12‐item World Health Organization Disability Assessment Schedule 2.0 score of <16%, assessed at 3 months and 1 year after surgery.ResultsThe final analysis included 601 patients who received TEA and 244 who received IV‐PCA. After IPTW, the weighted incidence of disability‐free survival at 3 months and 1 year was 60.5% and 61.4% in the TEA group and 78.3% and 66.2% in the IV‐PCA group, respectively. The adjusted OR for disability‐free survival at 3 months and 1 year was 0.84 (95% confidence interval [CI]: 0.50–1.39) and 1.21 (95% CI: 0.72–2.05), respectively, for the TEA group.ConclusionNo significant differences were observed in the disability‐free survival at 3 months and 1 year after elective thoracic and abdominal surgery in patients aged ≥55 years who received TEA or IV‐PCA.Significance statementThis study is the first in our setting to document the long‐term effects of patient‐controlled analgesia. In a post hoc analysis of our prospective cohort study, we show that although differences in chronic postsurgical pain exist at 3 months post‐surgery, disability‐free survival rates at 1 year do not differ irrespective of the choice of patient‐controlled analgesia. The findings of this study highlight the need for shared decision‐making between clinicians and patients.

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Effects of preoperative nutritional status on disability-free survival after cardiac and thoracic aortic surgery: a prospective observational study

et al. 2023

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Frailty and perioperative patient-reported disability in patients undergoing cardiac surgery: a pilot study

Cited by 10 publications

References 41 publications

Fried Frailty Phenotype Questionnaire scores and postoperative patient‐reported outcomes of patients undergoing major abdominal cancer surgery: A secondary analysis

Fried Frailty Phenotype Questionnaire scores and postoperative patient‐reported outcomes of patients undergoing major abdominal cancer surgery: A secondary analysis

Comparison between the effects of epidural and intravenous patient‐controlled analgesia on postoperative disability‐free survival in patients undergoing thoracic and abdominal surgery: A post hoc analysis

Effects of preoperative nutritional status on disability-free survival after cardiac and thoracic aortic surgery: a prospective observational study

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