The impact of frailty in aortic valve surgery.

Abstract

Background Frailty is a geriatric syndrome that diminishes potential functional recovery after any surgical procedure. Preoperative surgical risk assessment is crucial to calibrate the risk and benefit of cardiac surgery. The aim of this study was to test usefulness of FRAIL Scale and other surgical-risk-scales and individual features of frailty. Methods: Prospective study. From May-2014 to February-2016, we collected 200 patients who underwent aortic valve replacement, either surgically or transcatheter. At 1-year follow-up, quality of life measurements were recorded using the EQ-5D (EuroQol). Univariate and multivariate analyses correlated preoperative condition, features of frailty and predicted risk scores with mortality, morbidity and quality of life at 1 year of follow-up. Results: Mean age 78.2y, 56%male. Mean-preoperative-scores: FRAIL scale 1.5(SD 1.02), STS 2.9(SD 1.13), BI 93.8(SD 7.3), ESlog I 12.8(SD 8.5) and GS 7.3s (SD 1.9). Morbidity at discharge, 6 m and 1 year was 51%, 14% and 28%. Mortality 4%. Survival at 6m/ 1-y was 97% / 88%. Complication-rate was higher in TAVI group due to-vascular complications. Renal dysfunction, anemia, social dependence and GS slower than 7 seconds were associated with morbidity. On multivariate analysis adjusted STS, BI and GS speed were statistically significant. Quality of life at 1-year follow-up adjusted for age and prosthesis type showed a significant association with STS and FRAIL scale scores. Conclusions: Frailty increases surgical risk and is associated with higher morbidity. Preoperative GS slower 7 s, and STS and FRAIL scale scores seem to be reliable predictors of quality of life at 1-year follow-up.

Association Between the FRAIL Scale and Postoperative Complications in Older Surgical Patients: A Systematic Review and Meta-Analysis

“…21–23,32,35 Greater frailty at 6 months in 3 studies (n = 437) was also significantly associated with mortality (OR, 2.97 [95% CI, 1.54–5.72]; P < .01; I 2 = 20%; Figure 2B). 25,35,36 For 1-year mortality, 3 studies (n = 486) were pooled, and frailty based on the FRAIL scale was nonsignificantly associated with an OR of 1.54 (95% CI, 0.91–2.58; P = .11; I 2 = 0%; Figure 2C). 27,30,35…”

“…A total of 18 studies with 4479 participants 21–38 were included after screening 7800 citations and 85 full-text articles (Figure 1). An additional 4 studies were found to match our inclusion and exclusion criteria 39–42 ; however, they were missing necessary data for our analysis (ie, percent frail) 39–41 or used the same population as a previously published study.…”

“…The mean age was 74.8 years (6.54), and 49.48% were male. Five studies were from Spain, 23–25,35,38 8 were from the United States, 21,26–31,36 and other studies were from China, 32,37 Canada, 34 Poland, 33 and Italy. 22 The common types of surgery were abdominal, 23,24,26,32 cardiac, 25,33,35 and spinal.…”

“…42 Authors were contacted for additional data, and studies were excluded if authors did not respond or provide the additional data. All were observational studies with 16 prospective 23–38 and 2 retrospective cohort studies (Table 1). 21,22 The sample size varied from 58 to 672.…”

“…The lack of association of frailty with mortality at 1 year may be due to the relatively small numbers of patients in the studies reporting mortality at 1 year. 27,30,35 Frail patients had a 2.5-fold increased risk of postoperative complications such as cardiovascular, respiratory, infectious, and renal failure, and a 2.4-fold higher risk of postoperative delirium than nonfrail patients. This increased risk of experiencing postoperative delirium for participants classified as frail by the FRAIL scale is consistent with the increased risk for participants classified as frail by the Edmonton Frailty scale or Fried Phenotype.…”