The Changing Face of Cardiac Surgery: Frailty, Age, and Adverse Outcomes Create a Mandate for Shared Decision Making

Gainer, Robert S.; Buth, Karen J.; Legare, Janet M.; Hirsch, Gregory M.

doi:10.1016/j.cjca.2013.07.342

Cited by 2 publications

(1 citation statement)

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“…Such information can better inform and empower patients and caregivers in the decision-making process and ensure that realistic expectations are clear. 2,39,40 In light of the elevated risks associated with frailty, preoperative discussions should include frailty-related risk of adverse events following surgery, mortality, and potential loss of functional autonomy and independence. These details should be reconciled with individual symptoms and with what risk or trade-offs are acceptable to the patient.…”

Section: Discussionmentioning

confidence: 99%

Association between preoperative frailty and outcomes among adults undergoing cardiac surgery: a prospective cohort study

Montgomery

Stelfox

Norris

et al. 2021

cmajo

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F railty, defined as a state of exaggerated vulnerability to adverse health outcomes owing to the accumulation of age-related deficits, is increasingly recognized as an important factor associated with suboptimal outcomes for patients undergoing cardiac surgery. [1][2][3][4] Despite this association, there is no consistent screening strategy for frailty and limited incorporation of frailty-related functional measures into cardiac surgery risk scores or proven care pathways to mitigate the perioperative risk for vulnerable patients living with frailty.As the Canadian population ages, the incidence of frailty and concomitant cardiovascular disease prompting consideration for complex interventions are expected to grow. [5][6][7] Advances in intensive care and anesthetic and surgical techniques have improved outcomes, translating into older, more complex patients now routinely undergoing cardiac surgery. 5 Identifying patients with frailty before cardiac surgery may have relevance for prognostic and recovery purposes and support future improvement in care processes to better inform patients, caregivers, surgeons and decision-makers about preoperative opportunities (e.g., prehabilitation), perioperative risks, and short and longer-term postoperative care needs. The aim of this study was to estimate the prevalence of frailty and describe the associated clinical course and outcomes of patients referred for nonemergent cardiac surgery.

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Section: Discussionmentioning

confidence: 99%