Frailty Can Be Handled—First Results of the PREDARF Prospective Study (PREoperative Detection of Age-Related Factors)

Objectives: Among patients presenting for cardiovascular surgery, the percentage of elderly is growing constantly. Therefore, more frail patients are seen in our daily practice and it is our task as surgeons to evaluate the risk and benefit of an operation as minimal-invasive strategies are available. This study analyzes frailty scores and their predictive value in a cardiovascular patient population.

Methods: In this prospective observational study, all elective patients presenting for cardiac surgery were included. They were screened for frailty symptoms according to Fried (5-m walking test, weight loss, feeling fatigued or exhausted, hand grip strength, and activities per week). Pre-frail and frail patients were accumulated into the “frailty” group and compared to “non-frail” patients.

Results: A total of 247 patients were included; mean age was 67 ± 9 years, 78% male. Perioperative risk and comorbidities were not significantly different (Euroscore, LVEF, BMI, Gender, Hypertension, Diabetes, Age); 19.5% admitted to sometimes forget medication; 52.1% were classified pre-frail; and 5.6% frail according to Fried criteria. The frailty group underperformed the non-frail in a timed-up-and-go test (8.9 ± 1.5 vs. 10.6 ± 4.2 sec, < p < 0.001). This difference was also visible postoperatively (10.8 ± 2 vs. 11.8 ± 5 sec; p = 0.11). They reached less distance at a 6-minute walk (421.4 ± 75 vs. 349 ± 104 m, < p < 0.001 preoperatively and 330.9 ± 94 vs. 294.7 ± 103 m, p = 0.026 postoperatively). Handgrip, 6-minute walk and timed-up-and-go were impaired postoperatively in the frailty group as well as in the non-frail patients (all < p < 0.001). Preoperative self-rated quality of life (EQ5D-VAS) was rated lower by the frail group (67 ± 17 vs. 59 ± 19; p = 0.001). Mortality, stroke, wound healing disorders, myocardial infarction, pneumonia, and delirium rates did not significantly differ between groups. In-hospital stay was slightly longer in the frail group (13.5 ± 9 vs. 15.3 ± 8 days; p = 0.115). Of frail patients, less were discharged home, slightly more referred to another hospital unit (p = 0.012 discharge and p = 0.02 referral vs. non-frail).

Conclusion: Only a small portion of patients presenting for cardiac surgery presented with manifest frailty symptoms according to Fried, mainly reduction of mobility. This resulted in a longer hospital stay. Frail state is not that problematic in everyday cardiac surgery as propagated. Thus, well-planned surgery is still a valid option. A shift toward nonsurgical strategies merely based on frailty is not justified.

No conflict of interest has been declared by the author(s).