Frailty Assessment and Its Impact in Hospital Outcomes After Cardiac Surgery - A Prospective Observational Study

Abstract

Introduction Frailty increases the risk of adverse outcomes after cardiac surgery. However, there is no consensus on how to best assess it. Objective To verify the prevalence of frailty in patients undergoing elective valve surgery or coronary artery bypass grafting (CABG) and if a more comprehensive assessment of the physical, psychological, and nutritional domains would better discriminate the frailty phenotype and its association with in-hospital mortality. Methods Besides the criteria proposed by Fried, the Mini Nutritional Assessment, gait speed, Duke Activity Status Index, Dutch Exertion Fatigue Scale, and screening for depressive symptoms (Patient Health Questionnaire-9) were used. Results Overall, considering Fried’s criteria, 43.6% of the patients were frail, and 49.6% were pre-frail. Of those considered frail, 51% were under 60 years old. Fried’s frailty phenotype showed no association with postoperative in-hospital mortality. Using additional variables to characterize frailty domains, it was possible to distinguish two groups (clusters) of patients. In cluster 1, 84.8% were frail according to Fried’s criteria (vs. 27.4% in cluster 2, P < 0.001), the rate of postoperative infection was higher (24.2% vs. 7.1%, P = 0.022), and in-hospital mortality was significantly higher (27.3% vs. 9.5%, P = 0.020). Conclusion We observed a considerable proportion of patients with Fried frailty phenotype in patients undergoing CABG or valve surgery, many of them under 60 years old, but those frailty phenotypes were not associated with postoperative hospital outcomes. However, the association of frailty phenotype with higher rates of postoperative in-hospital mortality was evident when additional criteria were used to assess the domains associated with frailty.