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, = 0.004) and in intensive/intermediate care units (ITS/IMC) (FRAIL 5.4 ± 4.33 days vs. NON-FRAIL 4.86 ± 4.78 days, = 0.014). The 6 min walk (6 MW) (317.92 ± 94.17 m vs. 387.08 ± 93.43 m, = 0.006), mini mental status (MMS) (25.72 ± 4.36 vs. 27.71 ± 1.9, = 0.048) and clinical frail scale (3.65 ± 1.32 vs. 2.82 ± 0.86, = 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, = 0.037), Barthel index (TAU-0.114, = 0.032), hand grip strength (TAU-0.173, < 0.001), and EuroSCORE II (TAU 0.119, = 0.008). ICU/IMC stay duration correlated with TUG (TAU 0.186, < 0.001), 6 MW (TAU-0.149, = 0.002), and hand grip strength (TAU-0.22, < 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.