Ma Wenwen, Shui Weikang, Peng Qian, Zhu Chaoyang, Zhao Wenjing, Fan Guanglei, Zhu Shanshan
Department of Anaesthesiology, Xuzhou Cancer Hospital, Xuzhou, China.
Department of Anesthesiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China.
Front Med (Lausanne). 2025 Feb 19;12:1526896. doi: 10.3389/fmed.2025.1526896. eCollection 2025.
Disability may be a potential adverse outcome of exposure to stressors in frail patients, and assessment of frailty may provide additional information for preoperative decision-making, but there is a lack of research on the impact of preoperative frailty on death or new disability after cardiac surgery. The main objective of this study was to evaluate the effect of preoperative frailty on short-term death or new disability after cardiac surgery in elderly individuals.
This prospective cohort study included 351 patients aged ≥60 years who were scheduled to undergo elective open heart surgery at the Affiliated Hospital of Xuzhou Medical University from March 2023 to March 2024. Patients were examined prospectively using the Comprehensive Assessment of Frailty (CAF) score, which separated patients into frail and non-frail groups. The primary outcome was 90-day disability or death. Multivariate logistic regression models were used to estimate the association between frailty and 90-day new disability or death.
An assessment of frailty was performed on 351 patients, and 325 patients were included in the final analysis. The prevalence of frailty was found to be 23.08%. New disability or death occurred within 90 days after surgery in 41 (12.6%) of our patients. In multivariate analysis, frailty [OR, 3.31; 95% CI, 1.43-7.62] was independently associated with 90-day new disability or death. Empirical ROC analysis showed that CAF (AUC = 0.762) predicted 90-day new disability or death postoperatively more reliably than the traditional risk assessment tools ASA + age (AUC = 0.656) and EuroSCORE II (AUC = 0.643).
The study demonstrates that preoperative frailty, bypass time, diabetes, BMI and EuroSCORE II are independent risk factors for 90-day new disability or death after cardiac surgery in elderly patients. Notably, frailty was a more effective predictor of 90-day new disability or death than the traditional risk predictors EuroSCORE II and ASA + age.
残疾可能是体弱患者暴露于应激源后的潜在不良后果，对体弱程度的评估可为术前决策提供额外信息，但术前体弱对心脏手术后死亡或新发残疾的影响缺乏研究。本研究的主要目的是评估术前体弱对老年个体心脏手术后短期死亡或新发残疾的影响。
这项前瞻性队列研究纳入了2023年3月至2024年3月期间计划在徐州医科大学附属医院接受择期心脏直视手术的351例年龄≥60岁的患者。采用综合体弱评估（CAF）评分对患者进行前瞻性检查，将患者分为体弱组和非体弱组。主要结局是90天内的残疾或死亡。使用多因素逻辑回归模型估计体弱与90天新发残疾或死亡之间的关联。
对351例患者进行了体弱评估，最终分析纳入325例患者。发现体弱的患病率为23.08%。41例（12.6%）患者在术后90天内出现新发残疾或死亡。在多因素分析中，体弱[比值比（OR），3.31；95%置信区间（CI），1.43 - 7.62]与90天新发残疾或死亡独立相关。经验性ROC分析表明，CAF（曲线下面积[AUC] = 0.762）比传统风险评估工具美国麻醉医师协会（ASA）+年龄（AUC = 0.656）和欧洲心脏手术风险评估系统II（EuroSCORE II，AUC = 0.643）更可靠地预测术后90天新发残疾或死亡。
该研究表明，术前体弱、体外循环时间、糖尿病、体重指数和EuroSCORE II是老年患者心脏手术后90天新发残疾或死亡的独立危险因素。值得注意的是，与传统风险预测指标EuroSCORE II和ASA +年龄相比，体弱是90天新发残疾或死亡更有效的预测指标。
