Influence of Frailty Syndrome on Outcomes of Cardiovascular Surgery in Elderly Patients

TL;DR

Frailty in elderly patients undergoing heart surgery is linked to higher risks of death and complications, with specific criteria like FFP and CFS being most predictive.

Contribution

Identified FFP and CFS as independent risk factors for adverse outcomes in elderly cardiovascular surgery patients.

Findings

Frailty prevalence varied from 13.1% to 43.1% based on different criteria.

FFP and CFS criteria were independently associated with higher MACCE rates.

Frailty was linked to increased mortality and morbidity after surgery.

Abstract

Frailty syndrome is a significant risk factor for elderly patients undergoing
cardiovascular surgery. However, there is no consensus on which criteria are
most effective for assessing frailty in this context.

This study aimed to evaluate the relationship between different widely cited
frailty syndrome criteria and postoperative morbidity and mortality.

Patients aged ≥ 60 years scheduled for coronary artery bypass graft,
valve, and/or ascending aortic surgery were assessed for frailty
preoperatively. Frailty was defined by Clinical Frailty Scale (CFS) ≥
4, Katz Index ≥ 1, Short Physical Performance Battery (SPPB) ≤
6, Fried Frailty Phenotype (FFP) ≥ 3 or abnormal values in 15-feet
gait speed (GS) test, or hand grip strength. Clinical outcomes, including
mortality and major adverse cardiovascular and cerebral events (MACCE), were
assessed 30 days post-surgery.

Among 137 patients (70.1% male, mean age 69.43 ± 5.98 years), frailty
prevalence ranged from 13.1% to 43.1%, depending on criterion, with no
significant differences by age strata or surgery type. At 30-day follow-up,
mortality was 5.1% (n = 7), and a total of 29 MACCE (21.1%) were recorded.
Patients identified as frail by the FFP, CFS, SPPB, and GS criteria showed a
significant association with mortality and MACCE. Multivariate analysis
indicated FFP and CFS as independent risk factors for MACCE with equivalent
prognostic prediction.

Frailty is a prevalent condition among elderly patients undergoing
cardiovascular surgery and is associated with mortality and morbidity.
Frailty defined by FFP and CFS criteria was independently associated with
higher MACCE rates.

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