Key result
Slow preoperative gait speed linked to ~313% higher in-hospital morbidity in elderly AVR patients.
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.
Cohort (n=200)
No
Effect estimate: OR 4.13 (95% CI 30.82-571.0)
p-value: p=0.015
Preoperative frailty assessment, specifically gait speed, STS, and FRAIL scale scores, are reliable predictors of morbidity and 1-year quality of life in patients undergoing aortic valve replacement.
May inform preoperative frailty assessment in elderly AVR; hypothesis-generating and requires 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.
No takes yet. Share an insight, caveat, or question.
Berastegui et al. (2020) conducted a cohort in Aortic stenosis (n=200). Preoperative frailty (Gait speed ≥ 7 seconds) vs. Gait speed < 7 seconds was evaluated on In-hospital morbidity (OR 4.13, 95% CI 30.82-571.0, p=0.015). Preoperative gait speed slower than 7 seconds was significantly associated with increased in-hospital morbidity (OR 4.13) in elderly patients undergoing aortic valve replacement.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: