The Impact of Frailty on Functional Survival in Patients 1-Year Post-Cardiac Surgery
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Date
2015-08-07
Authors
Lytwyn, James
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Abstract
Frailty is an emerging concept in medicine yet to be adequately explored as a risk factor in cardiac surgery. Frailty is a geriatric syndrome of decreased physiologic reserves and increased vulnerability to stressors. It may be a strong predictor of adverse events following cardiac surgery such as post-operative delirium. Given that elderly patients are increasingly referred for cardiac surgery, the prevalence of frailty amongst this group is on the rise. Risk prediction, not just for mortality but also morbidity is pivotal in order to determine the optimal timing and selection for this increasingly complex group of patients. However, currently available risk scores (i.e. Euroscore II, Society of Thoracic Surgery) fail to account for the patient’s total physiologic reserves that will be called upon at the time of surgery. We have previously identified that, when using detailed frailty assessment tools, ~55% of elective cardiac surgery patients in Manitoba can be deemed frail. Preoperative frailty was associated with a 5-8-fold increase in the occurrence of postoperative delirium and prolonged hospital length of stay. While these represent important and novel findings, there is a pressing need to understand the longer-term impact of frailty before it can be integrated into current cardiac surgery risk scores. The study objective, therefore is to examine the mid- and long-term impact of frailty, with and without the co-occurrence of delirium, on outcomes following cardiac surgery. We ultimately aim to understand how incorporation of frailty assessment impact patient well-being in elderly patients undergoing cardiac surgery.
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Frailty, cardiac surgery