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. 2023 Sep;166(3):870-878.e6.
doi: 10.1016/j.jtcvs.2022.01.032. Epub 2022 Feb 3.

Preoperative frailty and one-year functional recovery in elderly cardiac surgery patients

Lisa Verwijmeren  1 , Peter G Noordzij  2 , Edgar J Daeter  3 , Marielle H Emmelot-Vonk  4 , Lisette M Vernooij  5 , Wilton A van Klei  6 , Eric P A van Dongen  1
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Free article

Preoperative frailty and one-year functional recovery in elderly cardiac surgery patients

Lisa Verwijmeren et al. J Thorac Cardiovasc Surg. 2023 Sep.
Free article

Abstract

Objective: Frailty increases risk for morbidity and mortality after cardiac surgery. Its influence on functional outcome is largely unknown. We studied the association of frailty with health-related quality of life and disability after cardiac surgery.

Methods: A prospective 2-center observational cohort of 555 patients aged 70 years or more undergoing cardiac surgery. A comprehensive frailty assessment was performed before surgery based on 11 individual assessments in physical, mental, and social domains. Frailty was defined as at least 1 positive test in each domain. The primary outcome was health-related quality of life over 1 year, and the secondary outcomes were severe in-hospital complications and disability over 1 year. Adverse functional outcome was defined as the composite of a decreased health-related quality of life and disability.

Results: Physical frailty was most common (91%) compared with mental (39%) or social frailty (42%). Adverse functional outcome occurred in 257 patients (46%) and consisted of decreased physical health-related quality of life in 134 (24%), decreased mental health-related quality of life in 141 (25%), and disability in 120 (22%). Frailty was more common in patients with adverse functional outcome (29%) compared with patients without adverse functional outcome (16%, P < .001). Poor mobility, malnutrition, and polypharmacy were associated with a decreased health-related quality of life over time, whereas impaired physical functioning and higher self-rated health were related to increased health-related quality of life. Disability after cardiac surgery was associated with poor mobility, polypharmacy, dependent living, living alone, and lower self-rated mental health before surgery.

Conclusions: Mobility, nutrition, medication use, physical functioning, and self-rated health before surgery are associated with health-related quality of life in elderly patients 1 year after cardiac surgery.

Trial registration: ClinicalTrials.gov NCT02535728.

Keywords: disability; frailty; functional outcome; health-related quality of life; older patients.

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Comment in

  • Commentary: Frailty: I know it when I see it.
    Blackstone EH. Blackstone EH. J Thorac Cardiovasc Surg. 2023 Sep;166(3):879-880. doi: 10.1016/j.jtcvs.2022.03.003. Epub 2022 Mar 8. J Thorac Cardiovasc Surg. 2023. PMID: 35410690 No abstract available.

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