Impact of frailty status on clinical and functional outcomes after concomitant valve replacement and bipolar radiofrequency ablation in patients aged 65 years and older

Abstract

Background To evaluate the prognostic value of frailty in older recipients of concomitant valve replacement (VR) and bipolar radiofrequency ablation (BRFA), we examined whether clinical and functional outcomes differed between frail and non-frail groups of older patients referred for concomitant VR and BRFA. Methods In a single-center retrospective observational cohort study, we compared the clinical and functional outcomes in frail versus non-frail patients. Frailty was assessed using the 5-item Cardiovascular Health Study (CHS) frailty scale. Patients were divided into two groups, frail and non-frail. Functional outcome was assessed using the internationally validated Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) questionnaire. Results We enrolled 185 patients aged ≥ 65 years who underwent concomitant VR and BRFA. About 36.2% (n = 67) of the patients were included in the frail group and the remaining patients (n = 118) in the non-frail group. Follow-up was complete with a median duration of 58 months (interquartile range 44–76 months). Significant differences were observed between the two groups with respect to postoperative pulmonary complications (frail vs. non-frail patients, 50.74% vs. 22.9%, respectively, P < .001) and hospital mortality (10.45% vs. 1.69%, respectively, P = .021). The frail group had a higher adjusted risk for all-cause mortality (adjusted HR 4.06; 95% CI 1.33 to 12.38; P = .014) and all-cause hospitalization (adjusted HR 2.24; 95% CI 1.12 to 4.50; P = .023). Frailty was associated with lower overall AFEQT scores at baseline (Estimate, − 0.400; 95% CI − 0.532 to − 0.267; P < .001). Compared to the non-frail group, the frail group continued to have lower overall AFEQT scores with no significant improvement in follow-up at 1 year and 2 years after concomitant VR and BRFA. Conclusion Frail patients had lower baseline AFEQT scores and were more likely to have adverse outcomes from postoperative pulmonary complications, and frailty was also an independent risk factor for long-term all-cause mortality and all-cause rehospitalization. Further studies are needed to assess the impact of frailty.

New Perianal Sepsis Risk Score Predicts Outcome of Elderly Patients with Perianal Abscesses

“…Our data suggest that the etiology and bacteriology of perianal abscesses in elderly patients differ from the disease in younger patients. However, as is known from other surgical interventions [ 17 , 18 , 19 , 20 , 21 , 22 ], our data also reveal that the frailty status of aged people—and not their chronological age—mainly determines the outcome in both the short as well as longer term after surgery for perianal abscesses. These findings are the expression of the multidimensional frailty syndrome, which involves physiological and psychological aspects and results in loss of functional reserve and increased vulnerability upon surgery, as stated recently by Cappe et al [ 18 ].…”

“…It is known from other formally trivial diseases in general surgery, that elderly patients are at higher risk for experiencing a more severe and complicated course [ 17 ]. However, it is less the chronologic age than the multidimensional frailty syndrome, which dramatically increases the risk for poor outcome and consecutively for additional resource utilization after various elective and urgent surgical interventions [ 17 , 18 , 19 , 20 , 21 , 22 ]. This is currently unknown for patients with perianal abscesses, thus further research is needed to investigate this relevant issue in more detail.…”