Frailty assessment to predict short term outcomes after cardiac surgery

Marshall, Liam E.; Griffin, Rayleene; Mundy, Julie

doi:10.1177/0218492316653557

Cited by 17 publications

(9 citation statements)

References 15 publications

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“…In comparison, a study of 152 cardiac surgery patients using 3 different frailty scales reported a prevalence of 20% to 46%, depending on the method chosen to define frailty 14. When 11 different frailty measures were compared in a similarly sized cardiac surgery cohort, a prevalence of 4.8% to 47% was reported 38. These diverse ranges likely reflect the diversity of frailty instruments used, the poor correlation between instruments, and the differences in the prevalence of frailty by age and surgery type.…”

Section: Discussionmentioning

confidence: 99%

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Tran

Dupuis

et al. 2018

JAHA

104

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BackgroundFrailty is increasing in prevalence and poses a formidable challenge for clinicians. The cardiac surgery literature consists primarily of small single‐center studies with limited follow‐up, and the epidemiological features of frailty remain to be elucidated in long‐term follow‐up.Methods and ResultsWe conducted a population‐based, retrospective, cohort study in Ontario, Canada, between 2008 and 2015. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty indicator (a multidimensional instrument validated for research using administrative data). The primary outcome was mortality. Mortality rates were calculated using the Kaplan‐Meier method. The hazard of death was assessed using a multivariable Cox proportional hazard model. Of 40 083 patients, 8803 (22%) were frail. At 4±2 years of follow‐up, age‐ and sex‐standardized mortality rate per 1000 person‐years was higher in frail (33; 95% confidence interval, 29–36) compared with nonfrail (22; 95% confidence interval, 19–24) patients. Frailty was associated with an increased risk of long‐term mortality (adjusted hazard ratio, 1.20; 95% confidence interval, 1.12–1.28) and greater differences in the survival of patients between 40 and 74 years of age than in those who were ≥85 years old.ConclusionsFrailty was present in a large proportion of patients undergoing coronary artery bypass grafting and was independently associated with long‐term mortality. The adjusted risk of frailty‐related death was inversely proportional to age. Our findings highlight the need for more comprehensive preoperative risk stratification models to assist with optimal selection of operative candidates. In addition, we identified the <75 years age group as a potential target for comprehensive preoperative optimization programs, such as cardiac prehabilitation, nutritional augmentation, and psychosocial support.

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Section: Discussionmentioning

confidence: 99%

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Tran

Dupuis

et al. 2018

JAHA

104

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“…One study reported on patients undergoing total aortic arch repair [ 12 ] and one study included a minority (15%) of transcatheter aortic valve replacements [ 27 ]. Pre-frail patients included those classified as “borderline,” [ 15 ] “intermediate,” [ 27 ] “moderate” [ 26 ], “middle tertile” (for 5 m gait speed) [ 14 ] and “pre-frail” [ 9 , 20 ] (Supplementary Table 1 ). The following reports were considered duplicate studies and analyzed together ([ 20 , 27 ] [ 26 , 28 , 29 ]).…”

Section: Methodsmentioning

confidence: 99%

Frailty and pre-frailty in cardiac surgery: a systematic review and meta-analysis of 66,448 patients

Lee

Yanagawa

et al. 2021

J Cardiothorac Surg

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Background The burden of frailty on cardiac surgical outcomes is incompletely understood. Here we perform a systematic review and meta-analysis of studies comparing frail versus pre-frail versus non-frail patients following cardiac surgery. Methods We searched MEDLINE and EMBASE databases until July 2018 for studies comparing cardiac surgery outcomes in “frail”, “pre-frail” and “non-frail” patients. Data was extracted in duplicate. Primary outcome was operative mortality. Results There were 19 observational studies with 66,448 patients. Frail patients were more likely female (risk ratio [RR]1.7; 95%CI:1.5–1.9), older (mean difference: 2.4; 95%CI:1.3–3.5 years older) with greater comorbidities and higher STS-PROM. Frailty (RR2.35; 95%CI:1.57–3.51; p < 0.0001) and pre-frailty (RR2.03; 95%CI:1.52–2.70; p < 0.00001) were associated with increased operative mortality compared with non-frail patients. Frailty was also associated with greater risk of prolonged hospital stay (RR1.83; 95%CI:1.61–2.08; p < 0.0001) and intermediate care facility discharge (RR2.71; 95%CI:1.45–5.05; p = 0.002). Frail (Hazard Ratio [HR]3.27; 95%CI:1.93–5.55; p < 0.0001) and pre-frail patients (HR2.30; 95%CI:1.29–4.09; p = 0.005) had worse mid-term mortality (median follow-up 1 years [range 0.5–4 years]). After adjustment for baseline imbalances, frailty was still associated with greater operative mortality (odds ratio [OR]1.97; 95%CI:1.51–2.57; p < 0.00001), intermediate care facility discharge (OR4.61; 95%CI:2.78–7.66; p < 0.00001) and midterm mortality (HR1.37; 95%CI:1.03–1.83; p = 0.03). Conclusion In patients undergoing cardiac surgery, frailty and pre-frailty were associated with 2-fold and 1.5-fold greater adjusted operative mortality, respectively, greater adjusted perioperative complications and frailty was associated with almost 5-fold risk of non-home discharge. Graphical abstract Burden of frailty and pre-frailty on cardiac surgical outcomes.

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“…Although there is a general agreement that good early and midterm outcomes can be achieved after a cardiac operation even in older patients [22][23][24][25][26], the effect that preoperative frailty might have on the postoperative quality of life has been poorly studied [2,11,27]. In the present study, we analyzed the changes in HRQoL according to the preoperative frailty status.…”

Section: Commentmentioning

confidence: 97%

Influence of Preoperative Frailty on Health-Related Quality of Life After Cardiac Surgery

Hycka

Menéndez

Prada

et al. 2019

The Annals of Thoracic Surgery

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Background. Frailty has emerged as one of the main predictors of worse outcomes after cardiac surgery, but scarce evidence is available about its influence on postoperative quality of life. Whether frail patients may improve their quality of life or not after the surgical procedure is a matter that still remains unclear.Methods. This observational and multicenter cohort study was conducted in 3 university-affiliated hospitals of three different regions of Spain (Madrid, Asturias, and Canary Islands). Patients were categorized into three ordinal levels of frailty (frail, prefrail, robust) using the Fried, FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale, and Clinical Frailty Scale frailty scales. We analyzed the changes on health-related quality-of-life for each level of frailty using the EuroQoL 5-Dimension 5 Level questionnaire before and 6 months after the operation.Results. The study included 137 patients, and 109 completed the 6-month follow-up.

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Frailty assessment to predict short term outcomes after cardiac surgery

Cited by 17 publications

References 15 publications

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Frailty and pre-frailty in cardiac surgery: a systematic review and meta-analysis of 66,448 patients

Influence of Preoperative Frailty on Health-Related Quality of Life After Cardiac Surgery

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