Key result
Combining STS score, Barthel Index, and gait speed strongly predicts post-AVR in-hospital morbidity with 0.92 AUC.
Why the study?
Preoperative surgical risk assessment is crucial to calibrate the risks and benefits of cardiac surgery, as frailty impairs potential functional recovery.
Do preoperative frailty and surgical risk scores predict mortality, morbidity, and quality of life in patients undergoing aortic valve replacement?
Cohort (n=200)
No
Do preoperative frailty and surgical risk scores predict mortality, morbidity, and quality of life in patients undergoing aortic valve replacement?
Effect estimate: AUC 0.92 (95% CI 0.86-0.95)
Preoperative frailty assessment using gait speed, STS, and FRAIL scale scores helps predict morbidity and 1-year quality of life in patients undergoing aortic valve replacement.
May aid preoperative morbidity stratification in elderly AVR; leaves open prospective validation before practice change.
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. 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 7.3s (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. 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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Berastegui et al. (2020) conducted a cohort in Aortic stenosis (n=200). Aortic valve replacement and frailty assessment was evaluated on In-hospital morbidity prediction (STS score, Barthel Index, and Gait Speed) (AUC 0.92, 95% CI 0.86-0.95). The combination of preoperative 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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