Longitudinal Trajectories and Determinants of Post‐Discharge Frailty in Older Adults Undergoing Cardiac Surgery: A 2‐Year Cohort Study

Q: What are the key findings of this study?

Elective cardiac surgery resulted in three distinct 2-year frailty trajectories (p<0.001), with 13.3% of older adults experiencing persistently high and worsening frailty.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Elective cardiac surgery in older adults (n=588). Intervention: Elective cardiac surgery vs. Group 1 (persistently low and improving frailty). Primary outcome: Longitudinal frailty trajectories assessed by Kihon Checklist (KCL) scores over 24 months after discharge (p=<0.001).

Q: What does this research mean for the field?

Frailty trajectories over two years following elective cardiac surgery in older adults follow three distinct patterns, with approximately one in eight patients experiencing persistent and progressively worsening frailty associated with factors including postoperative delirium, COPD, and impaired renal function. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To identify longitudinal trajectories of frailty over two years following cardiac surgery and determine clinical factors associated with frailty progression or improvement.

Kazuhisa Tsurumoto; Kenta Kamisaka; Kentaro IWATA; Masami Inokuma; Go Takamura; Akira Minei; Yusuke Ochi; Koji Sakurada; Yu Hojo; 淳一 西川; 将之 田原; Yosuke Takahashi; Satomi Kusaka; Masakazu Saitoh; Tomoyuki Morisawa; Tetsuya Takahashi

doi:10.1111/ggi.70885

November 1, 2026Geriatrics and gerontology international/Geriatrics & gerontology international

Longitudinal Trajectories and Determinants of Post‐Discharge Frailty in Older Adults Undergoing Cardiac Surgery: A 2‐Year Cohort Study

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Key result

Elective cardiac surgery leaves ~13% of older adults with persistently worsening 2-year frailty.

P<0.001
n=588

Why the study?

Longitudinal changes in frailty and the factors associated with its improvement or progression in patients undergoing cardiac surgery required elucidation.

What are the longitudinal trajectories and determinants of post-discharge frailty over 2 years in older adults undergoing elective cardiac surgery?

Key Points

To identify longitudinal trajectories of frailty over two years following cardiac surgery and determine clinical factors associated with frailty progression or improvement.
Multicenter prospective cohort study using registry data from 588 patients aged 65–89 years undergoing elective cardiac surgery in Japan.
Frailty was measured preoperatively and at 6, 12, and 24 months post-discharge using the Kihon Checklist.
Group-based trajectory modeling, linear mixed-effects models, and multinomial logistic regression were applied to evaluate frailty courses and risk factors.
Three distinct trajectories emerged: 50.5% showed low and improving frailty, 36.1% maintained moderate and stable frailty, and 13.3% had persistently high and progressively worsening frailty.
Linear mixed-effects modeling revealed a significant group-by-time interaction (p < 0.001), with continuous frailty progression restricted to the high-frailty group.
Worsening frailty was significantly associated with older age, lower body mass index, postoperative delirium, chronic obstructive pulmonary disease, lower hemoglobin levels, reduced Barthel index scores, reduced left ventricular ejection fraction, and impaired renal function.

Study Design

Type

Cohort (n=588)

Multicenter

Yes

Structured PICO

What are the longitudinal trajectories and determinants of post-discharge frailty over 2 years in older adults undergoing elective cardiac surgery?

P

Population

588 older Japanese adults (mean age 74.7 years, 41.0% female) undergoing elective cardiac surgery, followed for 24 months post-discharge.

E

Exposure

Elective cardiac surgery and baseline/perioperative risk factors (postoperative delirium, COPD, lower hemoglobin, lower Barthel index, advanced age, lower BMI, reduced LVEF, impaired renal function)

C

Comparator

Group 1 trajectory (persistently low and improving frailty scores, 50.5% of cohort)

O

Outcome

Longitudinal frailty trajectories assessed using the Kihon Checklist (KCL) preoperatively and at 6, 12, and 24 months after dischargepatient reported

Main Result

Absolute Event Rate: 13.3% vs 50.5%

p-value: p=<0.001

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Approximately one in eight older adults undergoing elective cardiac surgery experience persistent and progressively worsening frailty over 2 years, driven by identifiable clinical and functional risk factors.

Abstract

AIMS: To elucidate longitudinal changes in frailty and identify factors associated with its improvement or progression in patients undergoing cardiac surgery. METHODS: This multicenter prospective cohort study used data from the Japanese Cardiovascular Physiotherapy Network registry. Patients aged 65-89 years who underwent elective cardiac surgeries between May 2021 and December 2022 were included. Frailty was assessed using the Kihon Checklist (KCL) preoperatively and at 6, 12, and 24 months after discharge. Group-based trajectory modeling identified distinct frailty trajectories over 2 years. Multinomial logistic regression examined factors associated with trajectory group membership. Longitudinal changes in KCL scores were evaluated using linear mixed-effects models. RESULTS: Among 588 patients (mean age, 74.7 years; 41.0% female), three trajectories were identified. Group 1 (50.5%) showed persistently low and improving KCL scores, indicating favorable recovery. Group 2 (36.1%) exhibited moderate and stable frailty. Group 3 (13.3%) demonstrated persistently high and progressively worsening frailty. Compared with Group 1, membership in Group 3 was significantly associated with postoperative delirium, chronic obstructive pulmonary disease, lower hemoglobin levels, lower Barthel index scores, more advanced age, lower body mass index, reduced left ventricular ejection fraction, and impaired renal function. Linear mixed-effects modeling confirmed a significant group-by-time interaction (p < 0.001), with sustained frailty increases occurring only in Group 3. CONCLUSIONS: Frailty trajectories following cardiac surgery are heterogeneous; approximately one in eight patients experience persistent and progressive frailty over the first 2 postoperative years. Early identification of high-risk patients may enable targeted multidisciplinary interventions to improve long-term functional outcomes.

Discussion

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Cite This Study

Tsurumoto et al. (2026) conducted a cohort in Elective cardiac surgery in older adults (n=588). Elective cardiac surgery vs. Group 1 (persistently low and improving frailty) was evaluated on Longitudinal frailty trajectories assessed by Kihon Checklist (KCL) scores over 24 months after discharge (p=<0.001). Elective cardiac surgery resulted in three distinct 2-year frailty trajectories (p<0.001), with 13.3% of older adults experiencing persistently high and worsening frailty.

synapsesocial.com/papers/6aee6be671a7594806220d02 https://doi.org/10.1111/ggi.70885

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Longitudinal Trajectories and Determinants of Post‐Discharge Frailty in Older Adults Undergoing Cardiac Surgery: A 2‐Year Cohort Study

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Longitudinal Trajectories and Determinants of Post‐Discharge Frailty in Older Adults Undergoing Cardiac Surgery: A 2‐Year Cohort Study

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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