Addition of Frailty and Disability to Cardiac Surgery Risk Scores Identifies Elderly Patients at High Risk of Mortality or Major Morbidity
Why the study?
Does the addition of frailty and disability to cardiac surgery risk scores improve prediction of in-hospital postoperative mortality or major morbidity in elderly patients undergoing cardiac surgery?
Population
Elderly patients (≥70 years) undergoing coronary artery bypass and/or valve surgery
Comparison
Addition of frailty and disability measures to… vs Established cardiac surgery risk scores alone
Design
Cohort
Follow-up
in-hospital
Authors
Discussion
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Member takes
Implication
Supports adding frailty/disability measures to cardiac surgery risk scores for better risk stratification in elderly patients; leaves open need for prospective validation before routine adoption.
Key Points
- This study aims to determine the impact of incorporating frailty and disability into cardiac surgery risk scores for elderly patients.
- Prospective, multicenter cohort study involving elderly patients (≥70 years) undergoing coronary artery bypass and/or valve surgery in the U.S. and Canada.
- Assessment of four frailty scales, three disability scales, and five cardiac surgery risk scores in enrolled patients (N=152).
- Primary outcome measured was in-hospital postoperative mortality or major morbidity.
- 20-46% of patients were classified as frail based on the most predictive frailty scale (5-meter gait speed), OR 2.63 (95% CI, 1.17-5.90).
- 5-76% of patients showed at least one disability based on the Nagi scale with the most predictive result being ≥3 impairments, OR 2.98 (95% CI, 1.35-6.56).
- Incorporating frailty and disability improved model discrimination of cardiac surgery risk scores (AUC from 0.68-0.72 to 0.73-0.76).
Structured PICO
Does the addition of frailty and disability to cardiac surgery risk scores improve prediction of in-hospital postoperative mortality or major morbidity in elderly patients undergoing cardiac surgery?
P
Population
Elderly patients (≥70 years) undergoing coronary artery bypass and/or valve surgery
I
Intervention
Addition of frailty (e.g., 5-meter gait speed) and disability (e.g., Nagi scale) measures to established cardiac surgery risk scores
C
Comparator
Established cardiac surgery risk scores alone (Parsonnet score or STS-PROMM)
O
Outcome
STS composite end point of in-hospital postoperative mortality or major morbiditycomposite
Integrating frailty and disability assessments with standard cardiac surgery risk scores significantly improves the prediction of postoperative mortality and major morbidity in elderly patients.
Cite This Study
Afilalo et al. (2012) studied this question.