Frailty in cardiothoracic surgery: systematic review of the literature

Abstract

A preoperative surgical risk analysis is necessary and important for predicting clinical and surgical outcomes in a clinical setting. Various tools for evaluating the patient characteristics in order to forecast perioperative clinical outcomes have previously been described; however, an objective and precise preoperative risk assessment has not yet been established. In the last decade, the concept of frailty, which is a geriatric assessment that identifies disabilities and weaknesses in patients, has been used in order to predict clinical mortality and morbidity following invasive surgical interventions because the prevalence of elderly patients among those undergoing surgical interventions is increasing. Since there is currently no single generally accepted clinical definition of frailty, many clinical modalities are needed to evaluate the patients' geriatric activity of daily living. Quantifying the quality of frailty is an evolving challenge for predicting surgical risks preoperatively. In recent years, with the development of transcatheter aortic valve implantation (TAVI), this newly definitive preoperative surgical risk assessment tool, frailty, has become more important and is attracting interest in cardiothoracic surgical settings. Thus, this review summarized current consideration on the preoperative risk analysis by frailty as well as future perspectives and the potential of an ideal frailty risk assessment in cardiothoracic surgery, including the management of elderly patients and high-risk aortic valve stenosis by TAVI.

Kruchość chorych kierowanych na operacje kardiochirurgiczne — badanie pilotażowe

“…EFS includes questions related to most of these domains, and MFI also includes concomitant conditions that may adversely affect postoperative recovery and patient functioning. In line with the holistic approach to evaluate frailty, the cited literature [6][7][8][9][10][11][12] supports our hypothesis of the need to combine information obtained by objective (MFI) and subjective (EFS) evaluation of frailty.…”

“…This results in a vicious circle which may prove fatal for the patient. Increasing evidence indicate the importance of this problem in cardiac surgery [7,8].…”

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

“…Frailty is an emerging concept in perioperative medicine but remains a poorly recognized and poorly investigated syndrome in patients undergoing cardiac surgery 1, 2, 3, 4. It is increasing in prevalence and presents a formidable challenge for clinicians who work to optimize these patients 5.…”

Expert Opinion Percutaneous Coronary Intervention in Older People: Does Age Make a Difference?

“…11 Some of these tools, such as the Charlson index 12 or the outcome-based frailty index 13 can be extremely helpful when attempting to decide on how aggressively to manage an older person. Upward of 40 studies were published in the 4 years between 2010 and 2014 attempting to address frailty in the context of cardiovascular disease; 11,14,15 however, none were able to encompass the vast scope and spectrum this term covers. 10 Although the majority of the above studies assessed mortality following a cardiac event or procedure, 11,14,15 it is important to note that many of the older population will value quality of life over mortality risk or benefit, in essence wanting quality rather than quantity.…”

“…Upward of 40 studies were published in the 4 years between 2010 and 2014 attempting to address frailty in the context of cardiovascular disease; 11,14,15 however, none were able to encompass the vast scope and spectrum this term covers. 10 Although the majority of the above studies assessed mortality following a cardiac event or procedure, 11,14,15 it is important to note that many of the older population will value quality of life over mortality risk or benefit, in essence wanting quality rather than quantity. Using percutaneous coronary intervention (PCI) to treat symptoms reduces hospital readmissions but leads to increased frailty physically, through loss of muscle bulk, and mentally, through loss of confidence.…”