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01-12-2021 | Heart Surgery | Review

Frailty and pre-frailty in cardiac surgery: a systematic review and meta-analysis of 66,448 patients

Authors: Jessica Avery Lee, Bobby Yanagawa, Kevin R. An, Rakesh C. Arora, Subodh Verma, Jan O. Friedrich, on behalf of the Canadian Cardiovascular Surgery Meta-Analysis Working Group

Published in: Journal of Cardiothoracic Surgery | Issue 1/2021

Abstract

Background

The burden of frailty on cardiac surgical outcomes is incompletely understood. Here we perform a systematic review and meta-analysis of studies comparing frail versus pre-frail versus non-frail patients following cardiac surgery.

Methods

We searched MEDLINE and EMBASE databases until July 2018 for studies comparing cardiac surgery outcomes in “frail”, “pre-frail” and “non-frail” patients. Data was extracted in duplicate. Primary outcome was operative mortality.

Results

There were 19 observational studies with 66,448 patients. Frail patients were more likely female (risk ratio [RR]1.7; 95%CI:1.5–1.9), older (mean difference: 2.4; 95%CI:1.3–3.5 years older) with greater comorbidities and higher STS-PROM. Frailty (RR2.35; 95%CI:1.57–3.51; p < 0.0001) and pre-frailty (RR2.03; 95%CI:1.52–2.70; p < 0.00001) were associated with increased operative mortality compared with non-frail patients. Frailty was also associated with greater risk of prolonged hospital stay (RR1.83; 95%CI:1.61–2.08; p < 0.0001) and intermediate care facility discharge (RR2.71; 95%CI:1.45–5.05; p = 0.002). Frail (Hazard Ratio [HR]3.27; 95%CI:1.93–5.55; p < 0.0001) and pre-frail patients (HR2.30; 95%CI:1.29–4.09; p = 0.005) had worse mid-term mortality (median follow-up 1 years [range 0.5–4 years]). After adjustment for baseline imbalances, frailty was still associated with greater operative mortality (odds ratio [OR]1.97; 95%CI:1.51–2.57; p < 0.00001), intermediate care facility discharge (OR4.61; 95%CI:2.78–7.66; p < 0.00001) and midterm mortality (HR1.37; 95%CI:1.03–1.83; p = 0.03).

Conclusion

In patients undergoing cardiac surgery, frailty and pre-frailty were associated with 2-fold and 1.5-fold greater adjusted operative mortality, respectively, greater adjusted perioperative complications and frailty was associated with almost 5-fold risk of non-home discharge.

Graphical abstract

Burden of frailty and pre-frailty on cardiac surgical outcomes.

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Title: Frailty and pre-frailty in cardiac surgery: a systematic review and meta-analysis of 66,448 patients
Authors: Jessica Avery Lee
Bobby Yanagawa
Kevin R. An
Rakesh C. Arora
Subodh Verma
Jan O. Friedrich
on behalf of the Canadian Cardiovascular Surgery Meta-Analysis Working Group
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Heart Surgery
Heart Surgery
Published in: Journal of Cardiothoracic Surgery / Issue 1/2021
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-021-01541-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Frailty and pre-frailty in cardiac surgery: a systematic review and meta-analysis of 66,448 patients

Abstract

Background

Methods

Results

Conclusion

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Graphical abstract

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