How Can We Best Measure Frailty in Cardiosurgical Patients?

Background: Frailty is gaining importance in cardiothoracic surgery and is a risk factor for adverse outcomes and mortality. Various frailty scores have since been developed, but there is no consensus which to use for cardiac surgery. Methods: In an all-comer prospective study of patients presenting for cardiac surgery, we assessed frailty and analyzed complication rates in hospital and 1-year mortality, as well as laboratory markers before and after surgery. Results: 246 included patients were analyzed. A total of 16 patients (6.5%) were frail, and 130 patients (52.85%) were pre-frail, summarized in the frail group (FRAIL) and compared to the non-frail patients (NON-FRAIL). The mean age was 66.5 +/- 9.05 years, 21.14% female. The in-hospital mortality rate was 4.88% and the 1-year mortality rate was 6.1%. FRAIL patients stayed longer in hospital (FRAIL 15.53 +/- 8.5 days vs. NON-FRAIL 13.71 +/- 8.94 days, p = 0.004) and in intensive/intermediate care units (ITS/IMC) (FRAIL 5.4 +/- 4.33 days vs. NON-FRAIL 4.86 +/- 4.78 days, p = 0.014). The 6 min walk (6 MW) (317.92 +/- 94.17 m vs. 387.08 +/- 93.43 m, p = 0.006), mini mental status (MMS) (25.72 +/- 4.36 vs. 27.71 +/- 1.9, p = 0.048) and clinical frail scale (3.65 +/- 1.32 vs. 2.82 +/- 0.86, p = 0.005) scores differed between patients who died within the first year after surgery compared to those who survived this period. In-hospital stay correlated with timed up-and-go (TUG) (TAU: 0.094, p = 0.037), Barthel index (TAU-0.114, p = 0.032), hand grip strength (TAU-0.173, p < 0.001), and EuroSCORE II (TAU 0.119, p = 0.008). ICU/IMC stay duration correlated with TUG (TAU 0.186, p < 0.001), 6 MW (TAU-0.149, p = 0.002), and hand grip strength (TAU-0.22, p < 0.001). FRAIL patients had post-operatively altered levels of plasma-redox-biomarkers and fat-soluble micronutrients. Conclusions: frailty parameters with the highest predictive value as well as ease of use could be added to the EuroSCORE.

Automated summary

Frailty is an important risk factor in cardiothoracic surgery and various frailty scores have been developed. This study analyzed the frailty and outcomes of 246 patients undergoing cardiac surgery, finding that frail patients had longer hospital stays, higher complication rates, and increased 1-year mortality. Additionally, postoperative changes in laboratory markers were observed in frail patients.