Nutritional risk and frailty as targets for prehabilitation in older patients undergoing elective cardiac surgery

Background Frailty and malnutrition are common and potentially reversible conditions in older adults undergoing cardiac surgery. Early identification of these conditions is essential for individualized perioperative care planning. In clinical practice, screening for frailty and nutritional risk may represent an important component of advanced nursing assessment and prehabilitation pathways. Purpose The aim of this study was to assess the association between nutritional risk and frailty severity in elderly patients scheduled for elective cardiac surgery. Methods This single-centre observational study included 100 patients (40% women, mean age 71.7 ± 5.0 years) scheduled for elective cardiac surgery with cardiopulmonary bypass. Frailty was assessed using the Tilburg Frailty Indicator (TFI), and nutritional status was evaluated with the Mini Nutritional Assessment (MNA). Univariate and multivariable linear regression models were used to identify independent predictors of overall frailty and its components. Multicollinearity was assessed using the variance inflation factor (VIF). Statistical significance was set at p<0.05. Results Frailty was identified in 63% of patients, while 53% were at risk of malnutrition or malnourished; 43% met criteria for both conditions. In multivariable analysis, risk of malnutrition was an independent predictor of higher total TFI score (β=1.355; 95% CI 0.468–2.242; p=0.004) and higher physical frailty component (β=1.133; 95% CI 0.411–1.855; p=0.003). Higher serum potassium levels were independently associated with greater physical frailty severity (β=0.867; 95% CI 0.025–1.708; p=0.047). Overweight and obesity were independently associated with higher psychological frailty scores. Being in a stable relationship was independently associated with lower social frailty scores (β=−0.973; 95% CI −1.244 to −0.703; p<0.001). A non-significant trend toward prolonged hospitalization (>7 days) was observed in frail patients compared with non-frail patients (46% vs. 30%, p=0.163). Conclusions Frailty and nutritional risk are highly prevalent and frequently coexist in older patients undergoing cardiac surgery. Nutritional risk independently predicts frailty severity, particularly its physical component, indicating a potential target for nurse-led prehabilitation strategies. Incorporating structured frailty and nutritional screening into routine preoperative nursing assessment may facilitate individualized care planning and interdisciplinary prehabilitation in this high-risk population.