Is Preoperative Quality of Life a Predictor of Outcome?

Objectives: Frailty is gaining importance in cardiac surgery because of demographic change and increased risk for conventional surgery. Quantitative assessment of frailty may thus help to predict outcome but is demanding. Quality of life (QoL) as well as laboratory parameters have been shown to correlate with frailty but have not been systematically investigated in patients awaiting elective cardiac surgery.

Methods: Beginning with June 2016 all patients admitted for elective cardiac surgery were asked to rate their quality of life (QoL) using a visual analog scale from 0–10. In an all-comer study the first 200 patients were retrospectively analyzed regarding QoL, laboratory parameters, in-hospital mortality, morbidity and length of stay.

Results: Mean age was 67.5 ± 9.5 years (29.5% female). Average Body-Mass-Index was 29.07 ± 4.99 kg/m² (36.5% were obese). Surgical procedure was coronary artery bypass grafting in 48%, valve repair or replacement in 37%, and a combination of both in 23%. Mean EuroSCORE II was 3.06%, overall mortality was 3% (6 Patients; EuroSCORE II: 12.23% mean, 38.71 highest). 81% were hypertensive, 34.5% had diabetes, 16.5% chronic kidney injury, and 16% peripheral arterial occlusive disease. Preoperative QoL did not correlate significantly with preoperative NYHA state, early mortality as well as laboratory parameters (albumin, calcium, cholesterol, creatinine kinase, creatinine, CRP, gamma-GT, hemoglobin, HbA1c, hematocrit, leucocytes, partial clotting time, thrombocytes, total protein, TSH, triglycerides, uric nitrate, and vitamin D), perioperative stroke (7 patients), and acute renal failure (7 patients). Low QoL resulted in slightly longer ICU-stay and significantly longer total length of stay.

Conclusion: Self-assessed preoperative QoL appears to be a highly subjective parameter, which does not correlate with objective parameters for co-morbidity or frailty. It can thus not be readily used for outcome prediction.