BACKGROUND: Frailty is an emerging concept in medicine yet to be explored as a risk factor in cardiac surgery. Where elderly patients are increasingly referred for cardiac surgery, the prevalence of a frail group among these is also on the rise. We assessed frailty as a risk factor for adverse outcomes after cardiac surgery. METHODS AND RESULTS: Functional measures of frailty and clinical data were collected prospectively for all cardiac surgery patients at a single center. Frailty was defined as any impairment in activities of daily living (Katz index), ambulation, or a documented history of dementia. Of 3826 patients, 157 (4.1%) were frail. Frail patients were older, were more likely to be female, and had risk factors for adverse surgical outcomes. By logistic regression, frailty was an independent predictor of in-hospital mortality (odds ratio 1.8, 95% CI 1.1 to 3.0), as well as institutional discharge (odds ratio 6.3, 95% CI 4.2 to 9.4). Frailty was an independent predictor of reduced midterm survival (hazard ratio 1.5, 95% CI 1.1 to 2.2). CONCLUSIONS: Frailty is a risk for postoperative complications and an independent predictor of in-hospital mortality, institutional discharge, and reduced midterm survival. Frailty screening improves risk assessment in cardiac surgery patients and may identify a subgroup of patients who may benefit from innovative processes of care.
BACKGROUND: Frailty is an emerging concept in medicine yet to be explored as a risk factor in cardiac surgery. Where elderly patients are increasingly referred for cardiac surgery, the prevalence of a frail group among these is also on the rise. We assessed frailty as a risk factor for adverse outcomes after cardiac surgery. METHODS AND RESULTS: Functional measures of frailty and clinical data were collected prospectively for all cardiac surgery patients at a single center. Frailty was defined as any impairment in activities of daily living (Katz index), ambulation, or a documented history of dementia. Of 3826 patients, 157 (4.1%) were frail. Frail patients were older, were more likely to be female, and had risk factors for adverse surgical outcomes. By logistic regression, frailty was an independent predictor of in-hospital mortality (odds ratio 1.8, 95% CI 1.1 to 3.0), as well as institutional discharge (odds ratio 6.3, 95% CI 4.2 to 9.4). Frailty was an independent predictor of reduced midterm survival (hazard ratio 1.5, 95% CI 1.1 to 2.2). CONCLUSIONS: Frailty is a risk for postoperative complications and an independent predictor of in-hospital mortality, institutional discharge, and reduced midterm survival. Frailty screening improves risk assessment in cardiac surgery patients and may identify a subgroup of patients who may benefit from innovative processes of care.
Authors: Jonathan P Singer; Joshua M Diamond; Cynthia J Gries; Jamiela McDonnough; Paul D Blanc; Rupal Shah; Monica Y Dean; Beverly Hersh; Paul J Wolters; Sofya Tokman; Selim M Arcasoy; Kristy Ramphal; John R Greenland; Nancy Smith; Pricilla Heffernan; Lori Shah; Pavan Shrestha; Jeffrey A Golden; Nancy P Blumenthal; Debbie Huang; Joshua Sonett; Steven Hays; Michelle Oyster; Patricia P Katz; Hilary Robbins; Melanie Brown; Lorriana E Leard; Jasleen Kukreja; Matthew Bacchetta; Errol Bush; Frank D'Ovidio; Melanie Rushefski; Kashif Raza; Jason D Christie; David J Lederer Journal: Am J Respir Crit Care Med Date: 2015-12-01 Impact factor: 21.405
Authors: Megan A Feng; Daniel T McMillan; Karen Crowell; Hyman Muss; Matthew E Nielsen; Angela B Smith Journal: J Surg Res Date: 2014-07-05 Impact factor: 2.192