Key result
STS score, Barthel Index, and gait speed strongly predict post-AVR in-hospital morbidity with 0.92 AUC.
Why the study?
Preoperative surgical risk assessment is crucial to calibrate the risk and benefit of cardiac surgery, and this study aimed to test the usefulness of the FRAIL Scale, other surgical-risk scales, and individual features of frailty.
Do preoperative frailty scales predict morbidity, mortality, and quality of life in patients undergoing aortic valve replacement?
Cohort (n=200)
No
Do preoperative frailty scales predict morbidity, mortality, and quality of life in patients undergoing aortic valve replacement?
Effect estimate: AUC 0.92 (95% CI 0.86-0.95)
Preoperative frailty assessment, particularly using gait speed, STS, and FRAIL scale scores, is useful for predicting morbidity and 1-year quality of life in patients undergoing aortic valve replacement.
Supports frailty assessment for risk stratification in elderly AVR; hypothesis-generating and requires prospective validation before practice change.
BackgroundFrailty 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.MethodsProspective 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.ResultsMean 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 7.3s (SD 1.9). Morbidity at discharge, 6 m and 1 year was 51%, 14% and 28%. Mortality 4%. Survival at 6m/ 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 seconds 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.ConclusionsFrailty 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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Berastegui et al. (2020) conducted a cohort in Aortic stenosis (n=200). Aortic valve replacement (TAVI, stented, or sutureless) was evaluated on In-hospital morbidity (AUC 0.92, 95% CI 0.86-0.95). A combination of STS score, Barthel Index, and gait speed strongly predicted in-hospital morbidity (AUC 0.92) in patients older than 70 years undergoing aortic valve replacement.
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