Impact of Frailty Risk on Adverse Outcomes after Open Heart Valve Surgery in Older Patients: A Retrospective Cohort Study

Q: What are the key findings of this study?

High preoperative frailty risk (HFRS ≥5) was associated with a significantly higher risk of hospitalization-associated disability compared to low frailty risk (OR 3.49).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Valvular heart disease (n=4658). Intervention: High frailty risk (HFRS ≥5) vs. Low frailty risk (HFRS <5). Primary outcome: Proportion of patients with hospitalization-associated disability (HAD) (OR 3.49, 95% CI 2.60-4.67, p=<0.001).

Q: What question did this study set out to answer?

To investigate the impact of preoperative frailty risk, assessed using the Hospital Frailty Risk Score (HFRS), on hospitalization-associated disability (HAD) and in-hospital complications in patients aged 65 years or older undergoing open heart valve surgery.

Issei Kameda; Akio Shimizu; Kenta Ushida; Miho Shimizu; Kohei Ochiai; Yuki Kato; Ryo Momosaki

doi:10.2490/prm.20260024

January 1, 2026Progress in Rehabilitation MedicineOpen Access

Impact of Frailty Risk on Adverse Outcomes after Open Heart Valve Surgery in Older Patients: A Retrospective Cohort Study

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Key result

High frailty risk is linked to a ~3.5-fold higher risk of hospitalization-associated disability.

OR 3.49
95% CI 2.60-4.67
P<0.001
n=4,658

Figures

Why the study?

The study aimed to investigate the impact of preoperative frailty risk, assessed using the Hospital Frailty Risk Score, on hospitalization-associated disability and in-hospital complications after open heart valve surgery in older patients.

Does high preoperative frailty risk (HFRS ≥5) increase hospitalization-associated disability and in-hospital complications in older patients undergoing open heart valve surgery?

Key Points

To investigate the impact of preoperative frailty risk, assessed using the Hospital Frailty Risk Score (HFRS), on hospitalization-associated disability (HAD) and in-hospital complications in patients aged 65 years or older undergoing open heart valve surgery.
Retrospective cohort study of 4658 patients aged 65 years or older with valvular heart disease who underwent open heart valve surgery between April 2017 and December 2022 identified from the JMDC database.
Patients were categorized into low frailty risk (HFRS <5, n=4330) and high frailty risk (HFRS ≥5, n=328) groups, with mediation analysis evaluating direct and indirect effects through postoperative complications.
Hospitalization-associated disability occurred in 23.5% of high frailty risk patients compared to 7.7% of low frailty risk patients, showing an independent association after adjustment (OR, 3.49; 95% CI, 2.60–4.67; P <0.001).
High frailty risk was independently associated with higher rates of postoperative pneumonia (11.9% vs. 2.0%; OR, 7.27; 95% CI, 4.80–11.00; P <0.001), respiratory failure (14.3% vs. 2.9%; OR, 5.64; 95% CI, 3.92–8.27; P <0.001), and delirium (9.8% vs. 0.5%; OR, 22.74; 95% CI, 12.57–41.16; P <0.001).
Mediation analysis revealed a significant direct effect of frailty risk on disability (OR, 2.75; 95% CI, 2.01–3.76; P <0.001) alongside an indirect effect mediated by postoperative complications (OR, 1.26; 95% CI, 1.11–1.43; P <0.05), which accounted for 19% of the total effect.

Study Design

Type

Cohort (n=4,658)

Multicenter

Yes

Structured PICO

Does high preoperative frailty risk (HFRS ≥5) increase hospitalization-associated disability and in-hospital complications in older patients undergoing open heart valve surgery?

P

Population

4,658 patients aged 65 years or older with valvular heart disease who underwent open heart valve surgery, evaluated for hospitalization-associated disability.

E

Exposure

High frailty risk, defined as a Hospital Frailty Risk Score (HFRS) ≥5 at admission.

C

Comparator

Low frailty risk, defined as a Hospital Frailty Risk Score (HFRS) <5 at admission.

O

Outcome

Proportion of patients with hospitalization-associated disability (HAD), defined as a decrease of at least 5 points on the Barthel Index (BI) score at discharge compared with the BI score at admission.

Main Result

Odds Ratio: 3.49 (95% CI 2.6–4.67)

Absolute Event Rate: 23.5% vs 7.7%

p-value: p=<0.001

Preoperative frailty risk, as assessed by the Hospital Frailty Risk Score (HFRS), is a strong independent predictor of hospitalization-associated disability and in-hospital complications in older patients undergoing open heart valve surgery.

Limitations

Based on the Japanese healthcare system and the DPC database, limiting generalizability to other countries.
Diagnoses in the DPC database have high specificity but relatively low sensitivity, potentially underestimating the true burden of preoperative frailty.
In-hospital falls were not included as an outcome due to inconsistent reporting.
Patients who died during hospitalization were excluded, potentially introducing selection bias.
Important clinical data elements such as cognitive function, mobility, muscle strength, and intraoperative variables were not available, leaving potential residual confounding.
Based on the Japanese healthcare system and DPC database, limiting generalizability to other countries.
DPC diagnoses have high specificity but relatively low sensitivity, potentially underestimating the true burden of preoperative frailty.
In-hospital falls were not included as an outcome due to inconsistent reporting in the database.
Patients who died during hospitalization were excluded, which may have introduced selection bias.
Important clinical data elements (cognitive function, mobility, muscle strength, intraoperative variables) were unavailable, leaving potential for residual confounding.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May support preoperative frailty screening before valve surgery in older adults; hypothesis-generating and requires prospective validation.

Abstract

Objectives: This study aimed to investigate the impact of preoperative frailty risk, assessed using the Hospital Frailty Risk Score (HFRS), on hospitalization-associated disability (HAD) and in-hospital complications in patients aged 65 years or older who underwent open heart valve surgery. Methods: This retrospective cohort study included patients in the JMDC database aged 65 years or older with valvular heart disease who underwent open heart valve surgery between April 2017 and December 2022. Patients were categorized into low (HFRS <5) and high frailty risk (HFRS ≥5) groups. The primary outcome was the proportion of patients with HAD. The secondary outcomes included the proportion of patients who developed pneumonia, respiratory failure, and delirium during hospitalization. Mediation analysis was performed to examine whether preoperative frailty risk influenced the risk of HAD through postoperative complications. Results: Among 4658 patients (mean age 75.0 ± 5.5 years), 328 (7.0%) were classified as high frailty risk. The high risk group had a significantly higher proportion of HAD than the low risk group [odds ratio (OR), 3.49; 95% confidence interval (CI), 2.60-4.67; P <0.001]. Mediation analysis showed that high frailty risk was independently associated with HAD (direct effect: OR, 2.75; 95% CI, 2.01-3.76; P <0.001). The indirect effect mediated by postoperative complications was significant (OR, 1.26; 95% CI, 1.11-1.43; P <0.05), accounting for 19% of the total effect. Conclusions: The preoperative frailty risk assessed by the HFRS may serve as a useful predictor of HAD and in-hospital complications in older patients undergoing open heart valve surgery.

Discussion

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Cite This Study

Kameda et al. (2026) conducted a cohort in Valvular heart disease (n=4,658). High frailty risk (HFRS ≥5) vs. Low frailty risk (HFRS <5) was evaluated on Proportion of patients with hospitalization-associated disability (HAD) (OR 3.49, 95% CI 2.60-4.67, p=<0.001). High preoperative frailty risk (HFRS ≥5) was associated with a significantly higher risk of hospitalization-associated disability compared to low frailty risk (OR 3.49).

synapsesocial.com/papers/6a11439848a409a3a49de558 https://doi.org/10.2490/prm.20260024

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Impact of Frailty Risk on Adverse Outcomes after Open Heart Valve Surgery in Older Patients: A Retrospective Cohort Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Impact of Frailty Risk on Adverse Outcomes after Open Heart Valve Surgery in Older Patients: A Retrospective Cohort Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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