# Frailty Assessment to Improve Risk Stratification in Elderly Patients Undergoing Elective Cardiac Surgery

## TL;DR

This study explores how adding a frailty marker improves risk prediction for elderly patients undergoing heart surgery.

## Contribution

The study identifies serum albumin as a potential frailty marker to enhance existing cardiac surgery risk models.

## Key findings

- EuroSCORE II and serum albumin were significantly associated with postoperative adverse outcomes.
- Adding albumin to EuroSCORE II increased its predictive power for early postoperative mortality/morbidity.

## Abstract

Frailty is a biological syndrome of the elderly characterized by decreased
physiological reserve and weakened response to stressors. Most cardiac
surgical risk models incorporate chronologic age as a risk parameter, but
not frailty. We aimed to identify the frailty assessment tool with the
highest prognostic value to predict postoperative adverse outcomes in
elderly patients undergoing cardiac surgery and to investigate whether
addition of a frailty parameter to cardiac surgical risk models would
increase predictive power.

This is a single-center, prospective, observational study. Consecutive
adults, undergoing elective cardiac surgery between January and May 2020,
were included. The European System for Cardiac Operative Risk Evaluation II
(EuroSCORE II) and Society of Thoracic Surgeons risk scores were calculated.
Fried Scale, Short Physical Performance Battery, Clinical Frailty Scale, and
serum albumin were used for frailty assessment. Patients were followed-up
for 30 days postoperatively or until discharge. Primary endpoint was a
composite of mortality and major morbidity.

One hundred sixty-four patients were included (34.76% women, median age 70
years [interquartile range, 67-74]. EuroSCORE II and albumin were the only
tools significantly associated with the primary endpoint
(P=0.045 and P=0.031, respectively). Model
created by combination of EuroSCORE II and albumin was not associated with
the primary outcome (P=0.571), however EuroSCORE II’s
R-squared value increased from 0.07 to 0.144 after addition of albumin.

Addition of albumin measurement as a frailty marker to EuroSCORE II has the
potential to improve EuroSCORE II’s ability to predict early postoperative
mortality/morbidity in elderly patients undergoing cardiac surgery.