Frailty in Elderly Undergoing Cardiac Surgery
DOI:
https://doi.org/10.31584/psumj.2024270651Keywords:
cardiac surgery, elderly, frailtyAbstract
Currently, there is a growing population of elderly individuals with frailty who require cardiac surgery. Frail patients experience significantly higher rates of postoperative complications, in-hospital mortality, and prolonged stays in the ICU and hospital compared to those without frailty. Therefore, preoperative assessment of frailty is deemed essential for timely diagnosis and comprehensive care planning. This article has compiled knowledge on assessing frailty before surgery, as well as caring for patients with frailty throughout the preoperative, perioperative, and postoperative phases of cardiac surgery. This knowledge aims to improve the care of elderly individuals with frailty undergoing cardiac surgery.
References
Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013;38:752-62.
Graham A, Brown CHt. Frailty, Aging, and Cardiovascular Surgery. Anesth Analg 2017;124:1053-60.
Lee JA, Yanagawa B, An KR, Arora RC, Verma S, Friedrich JO. Frailty and pre-frailty in cardiac surgery: a systematic review and meta-analysis of 66,448 patients. J Cardiothorac Surg 2021;16:184.
Koh LY, Hwang NC. Frailty in cardiac surgery. J Cardiothorac Vasc Anesth 2019;33:521-31.
Gao F, Shan L, Wang C, Meng X, Chen J, Han L, et al. Predictive Ability of European Heart Surgery Risk Assessment System II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) Score for in-Hospital and Medium-Term Mortality of Patients Undergoing Coronary Artery Bypass Grafting. Int J Gen Med 2021;14:8509-19.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146-56.
Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc 2006;54:991-1001.
Wang X, Hu J, Wu D. Risk factors for frailty in older adults. Medicine (Baltimore) 2022;101:e30169.
Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, et al. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging 2019;23:771-87.
Cappe M, Laterre PF, Dechamps M. Preoperative frailty screening, assessment and management. Curr Opin Anaesthesiol 2023;36:83-8.
Ad N, Holmes SD, Patel J, Pritchard G, Shuman DJ, Halpin L. Comparison of EuroSCORE II, Original EuroSCORE, and the society of thoracic surgeons risk score in cardiac surgery patients. Ann Thorac Surg 2016;102:573-9.
Nashef SA, Roques F, Hammill BG, Peterson ED, Michel P, Grover FL, et al. Validation of European System for Cardiac Operative Risk Evaluation (EuroSCORE) in North American cardiac surgery. Eur J Cardiothorac Surg 2002;22:101-5.
Silverborn M, Nielsen S, Karlsson M. The performance of EuroSCORE II in CABG patients in relation to sex, age, and surgical risk: a nationwide study in 14,118 patients. J Cardiothorac Surg 2023;18:40.
Provenchère S, Chevalier A, Ghodbane W, Bouleti C, Montravers P, Longrois D, et al. Is the EuroSCORE II reliable to estimate operative mortality among octogenarians? PloS One 2017;12:e0187056.
Howell NJ, Head SJ, Freemantle N, van der Meulen TA, Senanayake E, Menon A, et al. The new EuroSCORE II does not improve prediction of mortality in high-risk patients undergoing cardiac surgery: a collaborative analysis of two European centres. Eur J Cardiothorac Surg 2013;44:1006-11.
Lee DH, Buth KJ, Martin BJ, Yip AM, Hirsch GM. Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation 2010;121:973-8.
Li Z, Ding X. The incremental predictive value of frailty measures in elderly patients undergoing cardiac surgery: a systematic review. Clin Cardiol 2018;41:1103-10.
Kovacs J, Moraru L, Antal K, Cioc A, Voidazan S, Szabo A. Are frailty scales better than anesthesia or surgical scales to determine risk in cardiac surgery? Korean J Anesthesiol 2017;70:157-62.
Jung P, Pereira MA, Hiebert B, Song X, Rockwood K, Tangri N, et al. The impact of frailty on postoperative delirium in cardiac surgery patients. J Thorac Cardiovasc Surg 2015;149:869-75.e1-2.
Sündermann S, Dademasch A, Praetorius J, Kempfert J, Dewey T, Falk V, et al. Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery. Eur J Cardiothorac Surg 2011;39:33-7.
Afilalo J, Mottillo S, Eisenberg MJ, Alexander KP, Noiseux N, Perrault LP, et al. Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcomes 2012;5:222-8.
Grossman Y, Barbash IM, Fefer P, Goldenberg I, Berkovitch A, Regev E, et al. Addition of albumin to Traditional Risk Score Improved Prediction of Mortality in Individuals Undergoing Transcatheter Aortic Valve Replacement. J Am Geriatr Soc 2017;65:2413-7.
Shimura T, Yamamoto M, Kano S, Kagase A, Kodama A, Koyama Y, et al. Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement. Circulation 2017;135:2013-24.
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005;173:489-95.
Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013;14:392-7.
Alvarez-Nebreda ML, Bentov N, Urman RD, Setia S, Huang JC, Pfeifer K, et al. Recommendations for preoperative management of frailty from the Society for Perioperative Assessment and Quality Improvement (SPAQI). J Clin Anesth 2018;47:33-42.
Robinson TN, Walston JD, Brummel NE, Deiner S, Brown CHt, Kennedy M, et al. Frailty for surgeons: review of a national institute on aging conference on frailty for specialists. J Am Coll Surg 2015;221:1083-92.
Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging 2012;16:601-8.
Subramaniam S, Aalberg JJ, Soriano RP, Divino CM. New 5-Factor Modified Frailty Index Using American College of Surgeons NSQIP Data. J Am Coll Surg 2018;226:173-81.e8.
Subramaniam S, Aalberg JJ, Soriano RP, Divino CM. The 5-factor modified frailty index in the geriatric surgical population. The American surgeon 2021;87:1420-5.
Luo J, Carter GC, Agarwal JP, Kwok AC. The 5-factor modified frailty index as a predictor of 30-day complications in pressure ulcer repair. J Surg Res 2021;265:21-6.
Segal DN, Wilson JM, Staley C, Michael KW. The 5-item modified frailty index is predictive of 30-day postoperative complications in patients undergoing kyphoplasty vertebral augmentation. World Neurosurg 2018;116:e225-e31.
Mogal H, Vermilion SA, Dodson R, Hsu FC, Howerton R, Shen P, et al. Modified Frailty Index Predicts morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol 2017;24:1714-21.
McIsaac DI, MacDonald DB, Aucoin SD. Frailty for perioperative clinicians: a narrative review. Anesth Analg 2020;130:1450-60.
Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing 2006;35:526-9.
Bautista L, DiDonato RM, Bennett KP, Bautista M. The Edmonton Frail Scale as a preoperative assessment tool in elective outpatient surgery. Can J Anaesth 2021;68:925-7.
Solomon J, Moss E, Morin JF, Langlois Y, Cecere R, de Varennes B, et al. The essential frailty toolset in older adults undergoing coronary artery bypass surgery. J Am Heart Assoc 2021;10:e020219.
Houben CHM, Spruit MA, Groenen MTJ, Wouters EFM, Janssen DJA. Efficacy of advance care planning: a systematic review and meta-analysis. J Am Med Dir Assoc 2014;15:477-89.
Oresanya LB, Lyons WL, Finlayson E. Preoperative assessment of the older patient: a narrative review. JAMA 2014;311:2110-20.
Santa Mina D, Clarke H, Ritvo P, Leung YW, Matthew AG, Katz J, et al. Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy 2014;100:196-207.
Stammers AN, Kehler DS, Afilalo J, Avery LJ, Bagshaw SM, Grocott HP, et al. Protocol for the PREHAB study-Pre-operative Rehabilitation for reduction of Hospitalization After coronary Bypass and valvular surgery: a randomised controlled trial. BMJ Open 2015;5:e007250.
Waite I, Deshpande R, Baghai M, Massey T, Wendler O, Greenwood S. Home-based preoperative rehabilitation (prehab) to improve physical function and reduce hospital length of stay for frail patients undergoing coronary artery bypass graft and valve surgery. J Cardiothorac Surg 2017;12:91.
Le Roy B, Selvy M, Slim K. The concept of prehabilitation: what the surgeon needs to know? J Visc Surg 2016;153:109-12.
Arthur HM, Daniels C, McKelvie R, Hirsh J, Rush B. Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery. a randomized, controlled trial. Ann Intern Med 2000;133:253-62.
Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, et al. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol 2014;63:747-62.
Shanker A, Upadhyay P, Rangasamy V, Muralidhar K, Subramaniam B. Impact of frailty in cardiac surgical patients-assessment, burden, and recommendations. Ann Card Anaesth 2021;24:133-9.
Rose AV, Duhamel T, Hyde C, Kent DE, Afilalo J, Schultz ASH, et al. Randomised controlled trial protocol for the PROTECT-CS Study: PROTein to Enhance outComes of (pre)frail paTients undergoing Cardiac Surgery. BMJ Open 2021;11:e037240.
McCann M, Stamp N, Ngui A, Litton E. Cardiac Prehabilitation. J Cardiothorac Vasc Anesth 2019;33:2255-65.
Stoppe C, Goetzenich A, Whitman G, Ohkuma R, Brown T, Hatzakorzian R, et al. Role of nutrition support in adult cardiac surgery: a consensus statement from an International Multidisciplinary Expert Group on Nutrition in Cardiac Surgery. Crit Care 2017;21:131.
Pozzi M, Mariani S, Scanziani M, Passolunghi D, Bruni A, Finazzi A, et al. The frail patient undergoing cardiac surgery: lessons learned and future perspectives. Front Cardiovasc Med 2023;10:1295108.
Hill A, Nesterova E, Lomivorotov V, Efremov S, Goetzenich A, Benstoem C, et al. Current evidence about nutrition support in cardiac surgery patients-what do we know? Nutrients 2018;10.
Ringaitiene D, Gineityte D, Vicka V, Zvirblis T, Norkiene I, Sipylaite J, et al. Malnutrition assessed by phase angle determines outcomes in low-risk cardiac surgery patients. Clin Nutr 2016;35:1328-32.
Volkert D, Berner YN, Berry E, Cederholm T, Coti Bertrand P, Milne A, et al. ESPEN guidelines on enteral nutrition: geriatrics. Clin Nutr 2006;25:330-60.
Khalid I, Doshi P, DiGiovine B. Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation. Am J Crit Care 2010;19:261-8.
Powell R, Scott NW, Manyande A, Bruce J, Vögele C, Byrne-Davis LM, et al. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst Rev 2016;2016:Cd008646.
de Labra C, Guimaraes-Pinheiro C, Maseda A, Lorenzo T, Millán-Calenti JC. Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials. BMC Geriatr 2015;15:154.
Partridge JS, Harari D, Martin FC, Peacock JL, Bell R, Mohammed A, et al. Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery. Br J Surg 2017;104:679-87.
Paille M, Senage T, Roussel JC, Manigold T, Piccoli M, Chapelet G, et al. Association of preoperative geriatric assessment with length of stay after combined cardiac surgery. Ann Thorac Surg 2021;112:763-9.
Engelman DT, Ben Ali W, Williams JB, Perrault LP, Reddy VS, Arora RC, et al. Guidelines for perioperative care in cardiac surgery: enhanced recovery after surgery society recommendations. JAMA Surg 2019;154:755-66.
Young CC, Harris EM, Vacchiano C, Bodnar S, Bukowy B, Elliott RRD, et al. Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations. Br J Anaesth 2019;123:898-913.
Chan MT, Cheng BC, Lee TM, Gin T. BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol 2013;25:33-42.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Author and Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
