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.
