TY - JOUR

T1 - One-year mortality increases four-fold in frail patients undergoing cardiac surgery

AU - Bäck, Caroline

AU - Hornum, Mads

AU - Jørgensen, Morten Buus

AU - Lorenzen, Ulver Spangsberg

AU - Olsen, Peter Skov

AU - Møller, Christian H.

PY - 2021

Y1 - 2021

N2 - OBJECTIVES: An increased focus on biological age, 'frailty', is important in an ageing population including those undergoing cardiac surgery. None of the existing surgery risk scores European System for Cardiac Operative Risk Evaluation II or Society of Thoracic Surgeons score incorporates frailty. Therefore, there is a need for an additional risk score model including frailty and not simply the chronological age. The aim of this study was to evaluate the impact of frailty assessment on 1-year mortality and morbidity for patients undergoing cardiac surgery. METHODS: A total of 604 patients aged ≥65 years undergoing non-acute cardiac surgery were included in this single-centre prospective observational study. We compared 1-year mortality and morbidity in frail versus non-frail patients. The Comprehensive Assessment of Frailty (CAF) score was used: This is a score of 1-35 determined via minor physical tests. A CAF score ≥11 indicates frailty. RESULTS: The median age was 73 years and 79% were men. Twenty-five percent were deemed frail. Frail patients had four-fold, odds ratios 4.63, 95% confidence interval (CI) 2.21-9.69; P < 0.001 increased 1-year mortality and increased risk of postoperative complications, i.e. surgical wound infections and prolonged hospital length of stay. A univariable Cox proportional hazards regression showed that an increased CAF score was a risk factor of mortality at any time after undergoing cardiac surgery (hazards ratios 1.11, 95% CI 1.07-1.14; P < 0.001). CONCLUSIONS: CAF score identified frail patients undergoing cardiac surgery and was a good predictor of 1-year mortality. CLINICAL TRIAL REGISTRATION NUMBER: NCT02992587.

AB - OBJECTIVES: An increased focus on biological age, 'frailty', is important in an ageing population including those undergoing cardiac surgery. None of the existing surgery risk scores European System for Cardiac Operative Risk Evaluation II or Society of Thoracic Surgeons score incorporates frailty. Therefore, there is a need for an additional risk score model including frailty and not simply the chronological age. The aim of this study was to evaluate the impact of frailty assessment on 1-year mortality and morbidity for patients undergoing cardiac surgery. METHODS: A total of 604 patients aged ≥65 years undergoing non-acute cardiac surgery were included in this single-centre prospective observational study. We compared 1-year mortality and morbidity in frail versus non-frail patients. The Comprehensive Assessment of Frailty (CAF) score was used: This is a score of 1-35 determined via minor physical tests. A CAF score ≥11 indicates frailty. RESULTS: The median age was 73 years and 79% were men. Twenty-five percent were deemed frail. Frail patients had four-fold, odds ratios 4.63, 95% confidence interval (CI) 2.21-9.69; P < 0.001 increased 1-year mortality and increased risk of postoperative complications, i.e. surgical wound infections and prolonged hospital length of stay. A univariable Cox proportional hazards regression showed that an increased CAF score was a risk factor of mortality at any time after undergoing cardiac surgery (hazards ratios 1.11, 95% CI 1.07-1.14; P < 0.001). CONCLUSIONS: CAF score identified frail patients undergoing cardiac surgery and was a good predictor of 1-year mortality. CLINICAL TRIAL REGISTRATION NUMBER: NCT02992587.

KW - Ageing

KW - Cardiac surgery

KW - Frailty

KW - Mortality

KW - Risk score

U2 - 10.1093/ejcts/ezaa259

DO - 10.1093/ejcts/ezaa259

M3 - Journal article

C2 - 32929483

AN - SCOPUS:85099427329

VL - 59

SP - 192

EP - 198

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 1

ER -