Frailty and pre-frailty in cardiac surgery: a systematic review and meta-analysis of 66,448 patients
| dc.contributor.author | Lee, Jessica A. | |
| dc.contributor.author | Yanagawa, Bobby | |
| dc.contributor.author | An, Kevin R. | |
| dc.contributor.author | Arora, Rakesh C. | |
| dc.contributor.author | Verma, Subodh | |
| dc.contributor.author | Friedrich, Jan O. | |
| dc.date.accessioned | 2021-07-01T04:12:46Z | |
| dc.date.issued | 2021-06-25 | |
| dc.date.updated | 2021-07-01T04:12:47Z | |
| dc.description.abstract | Abstract Background The burden of frailty on cardiac surgical outcomes is incompletely understood. Here we perform a systematic review and meta-analysis of studies comparing frail versus pre-frail versus non-frail patients following cardiac surgery. Methods We searched MEDLINE and EMBASE databases until July 2018 for studies comparing cardiac surgery outcomes in “frail”, “pre-frail” and “non-frail” patients. Data was extracted in duplicate. Primary outcome was operative mortality. Results There were 19 observational studies with 66,448 patients. Frail patients were more likely female (risk ratio [RR]1.7; 95%CI:1.5–1.9), older (mean difference: 2.4; 95%CI:1.3–3.5 years older) with greater comorbidities and higher STS-PROM. Frailty (RR2.35; 95%CI:1.57–3.51; p < 0.0001) and pre-frailty (RR2.03; 95%CI:1.52–2.70; p < 0.00001) were associated with increased operative mortality compared with non-frail patients. Frailty was also associated with greater risk of prolonged hospital stay (RR1.83; 95%CI:1.61–2.08; p < 0.0001) and intermediate care facility discharge (RR2.71; 95%CI:1.45–5.05; p = 0.002). Frail (Hazard Ratio [HR]3.27; 95%CI:1.93–5.55; p < 0.0001) and pre-frail patients (HR2.30; 95%CI:1.29–4.09; p = 0.005) had worse mid-term mortality (median follow-up 1 years [range 0.5–4 years]). After adjustment for baseline imbalances, frailty was still associated with greater operative mortality (odds ratio [OR]1.97; 95%CI:1.51–2.57; p < 0.00001), intermediate care facility discharge (OR4.61; 95%CI:2.78–7.66; p < 0.00001) and midterm mortality (HR1.37; 95%CI:1.03–1.83; p = 0.03). Conclusion In patients undergoing cardiac surgery, frailty and pre-frailty were associated with 2-fold and 1.5-fold greater adjusted operative mortality, respectively, greater adjusted perioperative complications and frailty was associated with almost 5-fold risk of non-home discharge. Graphical abstract Burden of frailty and pre-frailty on cardiac surgical outcomes. | |
| dc.identifier.citation | Journal of Cardiothoracic Surgery. 2021 Jun 25;16(1):184 | |
| dc.identifier.uri | https://doi.org/10.1186/s13019-021-01541-8 | |
| dc.identifier.uri | http://hdl.handle.net/1993/35727 | |
| dc.language.rfc3066 | en | |
| dc.rights | open access | en_US |
| dc.rights.holder | The Author(s) | |
| dc.title | Frailty and pre-frailty in cardiac surgery: a systematic review and meta-analysis of 66,448 patients | |
| dc.type | Journal Article | |
| local.author.affiliation | Rady Faculty of Health Sciences | en_US |