Frailty and cardiac surgery: to operate or not?

Emmert, Daniel A.; Arcario, Mark J.; Maranhao, Bruno; Reidy, Andrea B.

doi:10.1097/aco.0000000000001075

Cited by 3 publications

(2 citation statements)

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“…The prevalence of mild cognitive impairment (MCI) ( Winblad et al, 2004 ) in the general population, is 7%, while that of dementia is as high as 13% ( Luck et al, 2010 ). There are few publications on candidates for cardiac surgery with prior dementia, since these patients are usually deemed unsuitable for surgery (only 3% of candidates for cardiac surgery have prior dementia) or are referred for endovascular procedures due to their frailty ( Baldasseroni et al, 2020 ; Emmert et al, 2022 ). The scarce data available show cognitive decline rates of around 21% in these candidates ( Bendikaite and Vimantaite, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Influence of mild cognitive impairment on clinical and functional prognosis in older candidates for cardiac surgery

Harmand,

Mata,

Prada-Arrondo

et al. 2024

Front. Hum. Neurosci.

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IntroductionIn this study, we analyzed the prognostic impact of mild cognitive impairment (MCI) prior to cardiac surgery on 12-month clinical outcomes in older patients.MethodWe performed a longitudinal prospective study of 48 patients undergoing cardiac surgery and 26 neurologically healthy participants aged 65 years or older. All participants underwent a neuropsychological assessment. Functional status, quality of life and frailty were assessed in candidates for surgery. One year after surgery, 24 patients remained in the study.ResultsMild cognitive impairment (MCI) was diagnosed in 35% of the patients at baseline. Postsurgical changes in functionality consisted of a tendency toward impaired basic activities of daily living (BADL) in the MCI group and a statistically significant worsening in instrumental activities of daily living (IADL) in women with MCI. Changes in quality of life consisted of a significant improvement in anxiety-depression in the MCI group and a tendency toward greater pain-discomfort in the non-MCI group. Cognitive status significantly declined only in the non-MCI group. Neither group showed significant changes in frailty. Relative risk analysis showed that patients with a diagnosis of MCI at baseline had a higher risk of cognitive decline at follow-up, while those without a diagnosis of MCI at baseline had a lower risk of impaired IADL. No association was found between MCI and resource use. Preoperative impairment in memory, visuospatial and executive functions was significantly associated with loss of quality of life at follow-up. Impairment of memory and visuospatial function was significantly associated with cognitive decline. Preserved memory was associated with a lower risk of impaired BADL at follow-up.ConclusionThe present study provides clue on the impact of MCI in candidates for cardiac surgery. Preoperative detection of cognitive impairment could be highly valuable to help guide pre- and post-operative management.

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Section: Introductionmentioning

confidence: 99%

Influence of mild cognitive impairment on clinical and functional prognosis in older candidates for cardiac surgery

Harmand,

Mata,

Prada-Arrondo

et al. 2024

Front. Hum. Neurosci.

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“…Another meta-analysis found an association of frailty with postoperative delirium in age over 65 years [36]. In their review, Emmert et al [37] discuss the pertinent issues around frailty assessment and outcomes in the context of cardiac surgery, which is moving more towards the geriatric population where frailty is more prevalent. In clinical practice, understanding the implications of fragility when addressing the goals of care for the patient is essential.…”

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confidence: 99%

Editorial: cardiovascular anaesthesiology

Cherry

Nelson

Pal

2022

Current Opinion in Anaesthesiology

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Risk factors for postoperative delirium in frail elderly patients undergoing on-pump cardiac surgery and development of a prediction model—a prospective observational study

Ding,

Gao,

et al. 2024

Front. Cardiovasc. Med.

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BackgroundTo identify the risk factors for postoperative delirium (POD) after cardiac surgery in frail elderly patients and develop a receiver operating characteristic (ROC) prediction model to confirm the effectiveness.MethodsThis was a prospective observational study, patients were assessed preoperatively according to the frailty index (FI) scale. Cerebral (SctO2) was assessed at different time points using near-infrared spectroscopy (NIRS). On the basis of the occurrence of POD within 7 days after surgery, patients were divided into POD and non-POD groups. Risk factors were analyzed using logistic regression analysis, while their predictive values were evaluated using the receiver operating characteristic curve analysis.ResultsPOD was significantly associated with frailty, lower preoperative MMSE scores, hyperlipidemia, diabetes, cerebrovascular disease, lower hemoglobin level, lower albumin level, longer operation time, longer CPB time, lower SctO2 at T5, and lower SctO2baseline (P < 0.05). SrtO2 and SmtO2 did not differ significantly between groups. FI, preoperative MMSE score, and operation time as independent risk factors (P < 0.05). Significant predictive value was demonstrated in all 3 variables (P < 0.001; respectively). Among them, high sensitivity and specificity were observed with the FI (cut-off value 0.27, sensitivity 75%, specificity 73.5%) and operation time (cut-off value 237.5, sensitivity 62.5%, specificity 78.6%).ConclusionsThe FI, preoperative MMSE score, and operation time were independent risk factors for POD in elderly patients after cardiac surgery, with high predictive value observed with the FI and operation time. Cerebral oxygen saturation was associated with POD but was not an independent risk factor.Clinical Trial RegistrationChinese Clinical Trail Registry, No: chictr2200056038.

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Frailty and cardiac surgery: to operate or not?

Cited by 3 publications

References 50 publications

Influence of mild cognitive impairment on clinical and functional prognosis in older candidates for cardiac surgery

Influence of mild cognitive impairment on clinical and functional prognosis in older candidates for cardiac surgery

Editorial: cardiovascular anaesthesiology

Risk factors for postoperative delirium in frail elderly patients undergoing on-pump cardiac surgery and development of a prediction model—a prospective observational study

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