Changes in frailty status after cardiac surgery. A prospective cohort study.

BACKGROUND: The concept of frailty has become increasingly familiar in cardiac surgery. Since one of the characteristics of frailty is its reversible nature, efforts are being made to preoperatively decrease the level of frailty. However, the effect that the surgery itself may have in the postoperative frailty status remains still unknown. METHODS: A prospective cohort of 137 patients aged 70 or more undergoing major cardiac surgery were recruited at three hospitals in Spain. Frailty status was assessed preoperatively and six months after surgery using the Fried scale and the Clinical Frailty Scale (CFS). We analyzed the changes in these frailty scores and the transitions between frailty status after surgery. RESULTS: Mean age of participants was 78.3 years. 47.7% were female. Prevalence of frailty was 27.5% with the Fried Scale and 11% with the CFS. Up to 50% of frail patients improved their frailty status after surgery. The distribution of frailty among the study groups at baseline and six months after surgery changed significantly, decreasing the overall burden of frailty after surgery: 27.5% vs 17.4% of frail patients with the Fried Scale and 50.5% vs 29.4% of vulnerable or frail patients with the CFS (p<0.01). CONCLUSIONS: Frailty is a dynamic condition that can be significantly reduced after cardiac surgery, suggesting that cardiac pathology is an important contributor to the preoperative patient's frailty status.

Influence of Preoperative Frailty on Health-Related Quality of Life After Cardiac Surgery.

BACKGROUND: Frailty has emerged as one of the main predictors of worse outcomes after cardiac surgery, but scarce evidence is available about its influence on postoperative quality of life. Whether frail patients may improve their quality of life or not after the surgical procedure is a matter that still remains unclear. METHODS: This observational and multicenter cohort study was conducted in 3 university-affiliated hospitals of three different regions of Spain (Madrid, Asturias, and Canary Islands). Patients were categorized into three ordinal levels of frailty (frail, prefrail, robust) using the Fried, FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale, and Clinical Frailty Scale frailty scales. We analyzed the changes on health-related quality-of-life for each level of frailty using the EuroQoL 5-Dimension 5 Level questionnaire before and 6 months after the operation. RESULTS: The study included 137 patients, and 109 completed the 6-month follow-up. Median age of the entire cohort was 78 years (interquartile interval, 72 to 83 years). Frailty prevalence varied between 10% and 29%, depending on which scale was used. There was a statistically significant linear trend in the incidence of death or major morbidity among the different levels of frailty. On one hand, robust patients did not show significant changes in their previously high score of quality of life during follow-up. On the other hand, frail and prefrail patients significantly improved their scores after the operation. These results were comparable regardless the scale used for frailty assessment. CONCLUSIONS: Frail and prefrail patients have a significant improvement in their quality of life 6 months after their cardiac operation, and they have a proportionally greater increase in their postoperative health-related quality of life scores than robust patients.