Key result
Preoperative frailty in older patients undergoing cardiac surgery was associated with improved quality of life, but increased odds of non-home discharge (OR 3.02; 95% CI 1.57-5.82).
Why the study?
Frailty predicts increased mortality after cardiac surgery, but its association with quality of life and patient-centered outcomes is not fully understood.
Does preoperative frailty affect quality of life and patient-centered outcomes in older patients undergoing cardiac surgery?
Meta-Analysis (n=1,580)
Does preoperative frailty affect quality of life and patient-centered outcomes in older patients undergoing cardiac surgery?
Preoperative frailty in older patients undergoing cardiac surgery is associated with increased risk of non-home discharge and readmission, highlighting the importance of frailty assessment for patient-centered outcomes.
Frailty may associate with greater QoL gains yet higher readmission and non-home discharge risk after cardiac surgery; leaves open its utility for patient selection.
BACKGROUND: Frailty has emerged as an important prognostic marker of increased mortality after cardiac surgery, but its association with quality of life (QoL) and patient-centered outcomes is not fully understood. We sought to evaluate the association between frailty and such outcomes in older patients undergoing cardiac surgery. METHODS: This systematic review included studies evaluating the effect of preoperative frailty on QoL outcomes after cardiac surgery amongst patients 65 years and older. The primary outcome was patient's perceived change in QoL following cardiac surgery. Secondary outcomes included residing in a long-term care facility for 1 year, readmission in the year following the intervention, and discharge destination. Screening, inclusion, data extraction, and quality assessment were performed independently by two reviewers. Meta-analyses based on the random-effects model were conducted. The evidential quality of findings was assessed with the GRADE profiler. RESULTS: After the identification of 3105 studies, 10 observational studies were included (1580 patients) in the analysis. Two studies reported on the change in QoL following cardiac surgery, which was higher for patients with frailty than for patients without. Preoperative frailty was associated with both hospital readmission (pooled odds ratio [OR] 1.48 [0.80-2.74], low GRADE level) as well as non-home discharge (pooled OR 3.02 [1.57-5.82], moderate GRADE level). CONCLUSION: While evidence in this field is limited by heterogeneity of frailty assessment and non-randomized data, we demonstrated that baseline frailty may possibly be associated with improved QoL, but with increased readmission as well as discharge to a non-home destination following cardiac surgery. These patient-centered outcomes are important factors when considering interventional options for older patients. STUDY REGISTRATION: OSF registries (https://osf.io/vm2p8).
No takes yet. Share an insight, caveat, or question.
Fehlmann et al. (2023) conducted a meta-analysis in Cardiac surgery (n=1,580). Preoperative frailty vs. No frailty was evaluated on Patient's perceived change in QoL following cardiac surgery. Preoperative frailty in older patients undergoing cardiac surgery was associated with improved quality of life, but increased odds of non-home discharge (OR 3.02; 95% CI 1.57-5.82).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: