Abstract 16622: Frailty Predicts Outcomes in Elderly Patients Undergoing Cardiac Surgery
Background: Preoperative composite frailty measures have been shown to predict a multitude of postoperative outcomes in general surgical patients but there is little data on their predictive capacity on cardiac surgery (CS) outcomes. The aim of this study was to evaluate the predictive ability of a composite assessment of frailty in CS practice.
Methods: From April 2009 to April 2011, 1657 patients underwent CS at a single-center, tertiary-care hospital. Of these, 836 patients were ≥ 65 years of age and baseline frailty data were available on a convenience sample of 136. Operations included 20 (15%) isolated CABG, 31 (23%) isolated valve, and 85 (62%) combination and other-cardiac procedures. Frailty status was classified using modified Fried criteria including (1) unintentional weight loss, (2) weakness (grip strength), (3) exhaustion (SF 36 vitality subscale), (4) slowness (walking time, 15 feet), and (5) low activity (SF 36 physical function subscale). Of the 136, 17 (13%) patients met 3 or more criteria and were classified as frail (FR); the remaining 119 (87%) were non-FR. FR and non-FR patients were similar with respect to age (FR vs. non-FR) (74.5±6 vs. 74.6±5.9 years, p=0.95) and preoperative risk scores (Ambler[%]: 8.4±6.5 vs. 6.2±5.2, p=0.18; logEURO[%]: 20.1±12.8 vs. 14.1±12.7, p=0.07). More FR patients were female (71% vs. 31%; p=0.002) and had diabetes (53% vs. 23%; p=0.008).
Results: After adjusting for baseline Ambler score, logEURO score and SF36 mental health subscale, FR patients had an increased hospital length of stay (13.6±18.4 vs. 7.6±5.3 days, p=0.014), increased frequency of discharge to another medical care facility (OR=4.9, 95% CI=(1.4, 17.6), p=0.012), and decreased mental health score 3 months after surgery (n=59) (45.0±14.4 vs. 56.3±6.4 on a 0 [worst] to100 [best] scale, p<0.001). Mortality was similar in FR and non-FR patients at 30-days (0% vs. 2.5%, p=1.00) and at 90-days (5.7% vs. 6.1%, p=0.97). Rates of complications prior to discharge, and 30-day readmission were also similar.
Conclusion: Our composite frailty measure independently predicted more resource utilization and worse psychosocial outcomes after cardiac surgery. Assessment of frailty should be included in preoperative risk assessment in cardiac surgery.
- © 2011 by American Heart Association, Inc.