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

Abstract

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. 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%. 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). 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.