Pre-Frailty Increases the Risk of Adverse Events in Older Patients Undergoing Cardiovascular Surgery

Abstract

BackgroundFrailty is identified as a major predictor of adverse outcomes in older surgical patients. However, the outcomes in pre-frail patients after cardiovascular surgery remain unknown.ObjectiveTo investigate the main outcomes (length of stay, mechanical ventilation time, stroke and in-hospital death) in pre-frail patients in comparison with no-frail patients after cardiovascular surgery.Methods221 patients over 65 years old, with established diagnosis of myocardial infarction or valve disease were enrolled. Patients were evaluated by Clinical Frailty Score (CFS) before surgery and allocated into 2 groups: no-frailty (CFS 1~3) vs. pre-frailty (CFS 4) and followed up for main outcomes. For all analysis, the statistical significance was set at 5% (p < 0.05).ResultsNo differences were found in anthropometric and demographic data between groups (p > 0.05). Pre-frail patients showed a longer mechanical ventilation time (193 ± 37 vs. 29 ± 7 hours; p<0.05) than no-frail patients; similar results were observed for length of stay at the intensive care unit (5 ± 1 vs. 3 ± 1 days; p < 0.05) and total time of hospitalization (12 ± 5 vs. 9 ± 3 days; p < 0.05). In addition, the pre-frail group had a higher number of adverse events (stroke 8.3% vs. 3.9%; in-hospital death 21.5% vs. 7.8%; p < 0.05) with an increased risk for development stroke (OR: 2.139, 95% CI: 0.622-7.351, p = 0.001; HR: 2.763, 95%CI: 1.206-6.331, p = 0.0001) and in-hospital death (OR: 1.809, 95% CI: 1.286-2.546, p = 0.001; HR: 1.830, 95% CI: 1.476-2.269, p = 0.0001). Moreover, higher number of pre-frail patients required homecare services than no-frail patients (46.5% vs. 0%; p < 0.05).ConclusionPatients with pre-frailty showed longer mechanical ventilation time and hospital stay with an increased risk for cardiovascular events compared with no-frail patients.

Pre‐frailty status increases the risk of rehospitalization in patients after elective cardiac surgery without complication

“…Such mechanism has been previously described for patients with frailty, in which similar stress events cause a greater deterioration as compared to non‐frail patients, possibly requiring a longer period of functional dependence or often without returning to baseline homeostasis 4 . Therefore, precisely determining the presence of pre‐frailty during the preoperative period becomes extremely important since frailty may predict the risk of cumulative events (stroke or in‐hospital death) 8 . In addition, pre‐frailty is a condition that predisposes and directly precedes frailty 17 .…”

“…Rodrigues et al 8 recently demonstrated that pre‐frail patients are predisposed to increased hospitalization time and mortality after cardiac surgery. Therefore, the early detection of frailty and pre‐frail in patients undergoing cardiac surgery is critical for presurgical interventions to preserve their functional status 17,31 .…”

“…Our study has some limitations that should be addressed: (a) The inclusion criteria might limit the sample size of this study, but, we believe that this is the first study design to evaluate pre‐frail patients without complications after elective cardiac surgery. We decided to exclude patients with CFS more than five, as our objective was to evaluate pre‐frail patients without any surgical complications as our group recently had demonstrated that pre‐frail patients had worse outcomes after cardiac surgery in a short period of time 8 . So, this new study offers new perspectives for the future, as new protocols that include provisions for pre‐frail patients without complications.…”

“…In addition, frailty is a specific condition that involves malnutrition, weakness, slowness and inactivity, and denotes the patient's real functional capacity, regardless of chronological age. Most studies have evaluated the impact of frailty and pre‐frailty in the postoperative period immediately after cardiac surgery, with worse outcomes compared to patients who are non‐frail 7,8,11,12 . However, data on the prognosis and long‐term evolution in patients who have undergone elective cardiac surgery without postoperative complications are still scarce.…”

Community Centre-based Care services for a Frailty-Friendly Community in Singapore

“…Frailty is associated with higher functional and cognitive decline, 1 poorer clinical and surgical outcomes, 2,3 prolonged hospitalisations 4,5 and increased mortality. 4,6 e Canadian Study of Health and Aging Clinical Frailty Scale (CFS) is a measure of frailty based on clinical judgement, and has been validated as a predictor of adverse outcomes in community-dwelling adults.…”