What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Coronary artery disease requiring CABG. Intervention: Frailty vs. Non-frail. Primary outcome: 30-day all-cause mortality (OR 2.52, 95% CI 2.07 to 3.07).

December 27, 2024BMC Surgery11 citationsOpen Access

Impact of frailty on outcomes following coronary artery bypass grafting: a systematic review and meta-analysis

SCSaiya ChenZhejiang Chinese Medical University SZShengjing ZhangZhejiang Chinese Medical University SCShengsheng CaiHuzhou University

Key Result

Frailty was associated with a significant increase in 30-day mortality (OR 2.52) and 1-year mortality (OR 2.58) among patients undergoing coronary artery bypass grafting.

Study Design

Type

Meta-Analysis

Structured PICO

Does frailty increase the risk of mortality and adverse events in adult patients undergoing CABG?

Population

Adult patients undergoing coronary artery bypass grafting across 14 studies, comparing frail versus non-frail individuals to assess short- and long-term postoperative outcomes.

Exposure

Frail phenotype/status

Comparator

Non-frail phenotype/status

Outcome

All-cause mortality and major adverse cardiac events within one yearhard clinical

Frailty significantly increases short- and long-term mortality and acute kidney injury risk following CABG, highlighting the need for preoperative frailty assessment.

Main Result

Odds Ratio: 2.52 (95% CI 2.07–3.07)

Limitations

Significant heterogeneity observed in several outcomes like 30-day mortality and complications
Inclusion of predominantly high-income country studies limits applicability to lower-income settings
Relatively small number of studies in some analyses
Potential susceptibility to publication bias

Abstract

BACKGROUND: Coronary artery bypass grafting (CABG) remains the preferred treatment for complex multi-vessel coronary artery disease, offering substantial long-term benefits. Non-cardiac comorbidities such as frailty may significantly affect the outcomes of this procedure. However, the exact impact of frailty on CABG outcomes remains unclear, particularly given its exclusion from many pivotal revascularization trials. This systematic review and meta-analysis aimed to consolidate existing data to evaluate the impact of frailty on short- and long-term outcomes following CABG. METHODS: Searches across PubMed, Cochrane Library, Embase, and Scopus were done to identify studies that were published up to March 31, 2024, had detailed preoperative frailty assessments and compared frail versus non-frail adult patients undergoing CABG. Primary outcomes were all-cause mortality and major adverse cardiac events within one year. Secondary outcomes included hospital readmission rates and length of stay. A random-effects model was used to account for heterogeneity. Results were reported as odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI). RESULTS: Our meta-analysis, involving data from 14 studies, revealed a significant increase in both 30-day (OR 2.52; 95% CI: 2.07 to 3.07) and 1-year mortality (OR 2.58; 95% CI: 1.49 to 4.45) among frail patients. The risk of acute cardiac and cerebrovascular complications was comparable in all patients (OR 1.03; 95% CI: 0.89 to 1.19). However, frailty was associated with a significant increase in the risk of acute kidney injury (OR 2.31; 95% CI: 1.26 to 4.23). Frail patients were more likely to have longer hospital stays and higher readmission rates compared to their non-frail counterparts. CONCLUSION: Our study confirms the critical impact of frailty on mortality and morbidity in CABG patients and advocates for the integration of frailty assessments into the preoperative evaluation process. Addressing frailty can lead to more individualized patient care and better outcomes, urging a paradigm shift towards comprehensive, patient-centric management in cardiac surgery. PROSPERO REGISTER: CRD42024521327.

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