Rosie Fountotos1, Haroon Munir1, Michael Goldfarb2, Sandra Lauck3, Dae Kim4, Louis Perrault5, Rakesh Arora6, Emmanuel Moss7, Lawrence G Rudski2, Melissa Bendayan1, Palina Piankova1, Victoria Hayman8, Julia Rodighiero8, Marie-Claude Ouimet9, Sarah Lantagne8, Nicolo Piazza10, Jonathan Afilalo11. 1. Division of Experimental Medicine, McGill University, Montréal, Québec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada. 2. Division of Cardiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada. 3. Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 4. Division of Geriatric Medicine, Beth Israel Deaconess Medical Centre, Harvard University, Boston, Massachusetts, USA. 5. Division of Cardiac Surgery, Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada. 6. Division of Cardiac Surgery, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. 7. Division of Cardiac Surgery, Jewish General Hospital, McGill University, Montréal, Québec, Canada. 8. Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada. 9. Research Institute, McGill University Health Centre, Montréal, Québec, Canada. 10. Division of Cardiology, McGill University Health Centre, Montréal, Québec, Canada. 11. Division of Experimental Medicine, McGill University, Montréal, Québec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada; Division of Cardiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada; Research Institute, McGill University Health Centre, Montréal, Québec, Canada. Electronic address: jonathan.afilalo@mcgill.ca.
Abstract
BACKGROUND: Although multidimensional frailty scales have been proven to predict mortality and morbidity in cardiac surgery, there is a need for rapid tools that could be easily administered at the point of care. Handgrip strength (HGS) is an attractive option that can be measured in acutely ill and bed-bound patients, although it has yet to be validated in a large cardiac surgery cohort. METHODS: This is a post hoc analysis of a multicentre prospective study in older patients undergoing coronary artery bypass grafting and/or valve surgery from 2011 to 2019. HGS was measured before surgery and classified by sex-stratified cutoffs. The primary outcome was 1-year mortality and secondary outcomes were 30-day mortality, discharge disposition, and prolonged length of stay. RESULTS: There were 1245 patients included in the analysis (mean age 74.0 ± 6.6 years; 30% female). Weak HGS was associated with advanced age, heart failure, kidney disease, malnutrition, and various frailty scales. In those with weak vs normal HGS, respectively, 1-year mortality was 17% vs 6%, 30-day mortality was 10% vs 3%, prolonged length of stay was 34% vs 19%, and discharge to a health care facility was 45% vs 26% (all P < 0.001). After adjustment, HGS was predictive of 1-year and 30-day mortalities, with odds ratios of 2.44 (95% confidence interval [CI] 1.39-4.29) and 2.83 (1.38-5.81), respectively. HGS cutoffs of < 26 kg in men and < 16 kg in women had the highest predictive performance. CONCLUSIONS: HGS is a simple and effective tool to identify patients at higher risk of mortality and protracted recovery after cardiac surgery.
BACKGROUND: Although multidimensional frailty scales have been proven to predict mortality and morbidity in cardiac surgery, there is a need for rapid tools that could be easily administered at the point of care. Handgrip strength (HGS) is an attractive option that can be measured in acutely ill and bed-bound patients, although it has yet to be validated in a large cardiac surgery cohort. METHODS: This is a post hoc analysis of a multicentre prospective study in older patients undergoing coronary artery bypass grafting and/or valve surgery from 2011 to 2019. HGS was measured before surgery and classified by sex-stratified cutoffs. The primary outcome was 1-year mortality and secondary outcomes were 30-day mortality, discharge disposition, and prolonged length of stay. RESULTS: There were 1245 patients included in the analysis (mean age 74.0 ± 6.6 years; 30% female). Weak HGS was associated with advanced age, heart failure, kidney disease, malnutrition, and various frailty scales. In those with weak vs normal HGS, respectively, 1-year mortality was 17% vs 6%, 30-day mortality was 10% vs 3%, prolonged length of stay was 34% vs 19%, and discharge to a health care facility was 45% vs 26% (all P < 0.001). After adjustment, HGS was predictive of 1-year and 30-day mortalities, with odds ratios of 2.44 (95% confidence interval [CI] 1.39-4.29) and 2.83 (1.38-5.81), respectively. HGS cutoffs of < 26 kg in men and < 16 kg in women had the highest predictive performance. CONCLUSIONS: HGS is a simple and effective tool to identify patients at higher risk of mortality and protracted recovery after cardiac surgery.