Key result
Preoperative frailty linked to ~180% higher in-hospital morbidity risk after AVR.
Why the study?
Preoperative surgical risk assessment is crucial in cardiac surgery, but the usefulness of the FRAIL Scale, other surgical-risk scales, and individual frailty features in aortic valve surgery needed evaluation.
Do preoperative frailty and surgical risk scales predict mortality, morbidity, and quality of life at 1 year in patients undergoing aortic valve replacement?
Cohort (n=200)
No
Do preoperative frailty and surgical risk scales predict mortality, morbidity, and quality of life at 1 year in patients undergoing aortic valve replacement?
Effect estimate: OR 2.8 (95% CI 1.2-6.4)
p-value: p=0.01
Preoperative frailty assessment using the FRAIL scale, STS score, and gait speed can reliably predict morbidity and 1-year quality of life in patients undergoing surgical or transcatheter aortic valve replacement.
Supports preoperative gait speed assessment to flag AVR morbidity risk; hypothesis-generating for frailty modification in prospective studies.
BACKGROUND: Frailty is a geriatric syndrome that diminishes potential functional recovery after any surgical procedure. Preoperative surgical risk assessment is crucial to calibrate the risk and benefit of cardiac surgery. The aim of this study was to test usefulness of FRAIL Scale and other surgical-risk-scales and individual features of frailty in cardiac aortic valve surgery. METHODS: Prospective study. From May-2014 to February-2016, we collected 200 patients who underwent aortic valve replacement, either surgically or transcatheter. At 1-year follow-up, quality of life measurements were recorded using the EQ-5D (EuroQol). Univariate and multivariate analyses correlated preoperative condition, features of frailty and predicted risk scores with mortality, morbidity and quality of life at 1 year of follow-up. RESULTS: Mean age 78.2y, 56%male. Mean-preoperative-scores: FRAIL scale 1.5(SD 1.02), STS 2.9(SD 1.13), BI 93.8(SD 7.3), ESlog I 12.8(SD 8.5) and GS 7.3 s (SD 1.9). Morbidity at discharge, 6 m and 1 year was 51, 14 and 28%. Mortality 4%. Survival at 6 m/ 1-y was 97% / 88%. Complication-rate was higher in TAVI group due to-vascular complications. Renal dysfunction, anemia, social dependence and GS slower than 7 s were associated with morbidity. On multivariate analysis adjusted STS, BI and GS speed were statistically significant. Quality of life at 1-year follow-up adjusted for age and prosthesis type showed a significant association with STS and FRAIL scale scores. CONCLUSIONS: Frailty increases surgical risk and is associated with higher morbidity. Preoperative GS slower 7 s, and STS and FRAIL scale scores seem to be reliable predictors of quality of life at 1-year follow-up.
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García et al. (2020) conducted a cohort in Aortic stenosis (n=200). Aortic valve replacement (TAVI, stented, or sutureless) was evaluated on In-hospital morbidity (OR 2.8, 95% CI 1.2-6.4, p=0.01). Preoperative frailty, indicated by a gait speed slower than 7 seconds, significantly increased the risk of in-hospital morbidity (OR 2.8) following aortic valve replacement.
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