Frailty and perioperative patient-reported disability in patients undergoing cardiac surgery: a pilot study. (June 2022)

• Record Type: Journal Article
• Authors: Milne, Benjamin; Lucas de Carvalho, Joshua; Ayis, Salma; Chaubey, Sanjay; Khan, Habib; Kunst, Gudrun
• Is Part Of: British journal of anaesthesia. Volume 128:Number 6(2022)
• Page Start: 949
• Page End: 958
• Publication Date: 2022-06
• Subjects: cardiac surgery -- disability -- frailty -- patient-centred outcome -- postoperative outcome; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1016/j.bja.2022.03.015
• Languages: English
• ISSNs: 0007-0912

Abstract

Abstract: Background: Preoperative frailty may predispose patients to poorer outcomes in cardiac surgery; however, there are limited data concerning how preoperative frailty predicts patient-centred outcomes, such as patient-reported disability. Our objective was to evaluate the association between preoperative frailty and postoperative disability. Methods: Patients were prospectively evaluated using the Comprehensive Assessment of Frailty score, separating patients into frail and non-frail cohorts. Disability levels were quantified using the WHO Disability Assessment Schedule (WHODAS) 2.0 in percentage of the maximum disability score, with disability defined as a value ≥25%. Results: Frail patients had increased median [inter-quartile range] disability scores of 31 [16–45]% preoperatively, 29 [9–54]% at 1 month, and 15 [3–31]% at 3 months postoperatively, compared with disability scores in non-frail patients of 10 [5–17]%, 17 [6–29]%, and 2.1 [0–12.0]%, respectively. Preoperative frailty was associated with a reduced likelihood of patients being free of disability and alive at 3 months; adjusted odds ratio 0.51 (for age, European System for Cardiac Operative Risk Evaluation II, and WHODAS 2.0: 12-Part Questionnaire score); P =0.045. The trajectory of disability scores, assessed in percentage change from the preoperative baseline, showed non-frail patients had increased disability burden at 1 month, whereas frail patients had reduced disability burden (+4.2% vs –2.1%; P =0.04). Although the disability burden decreased for both groups at 3 months, this was most marked for frail patients (–6.3% vs –10.4%; P =0.02). Conclusions: Disability burden in frail patients improves continuously postoperatively, whereas in non-frail patients, it worsens at 1 month before improving at 3 months postoperatively. This positive trajectory of patient-centred outcomes in frail patients should be considered in preoperative decision-making.