Frailty Assessment to Improve Risk Stratification in Elderly Patients Undergoing Elective Cardiac Surgery.

Area of Science:

• Gerontology
• Cardiovascular Surgery
• Clinical Risk Assessment

Background:

• Frailty, a syndrome of decreased physiological reserve in the elderly, is not typically included in cardiac surgical risk models.
• Current models primarily use chronological age, potentially underestimating risk in frail elderly patients undergoing cardiac surgery.

Purpose of the Study:

• To identify the most prognostic frailty assessment tool for predicting adverse outcomes in elderly patients undergoing cardiac surgery.
• To evaluate if incorporating a frailty parameter enhances the predictive power of existing cardiac surgical risk models.

Main Methods:

• A prospective, observational study included 164 adult patients undergoing elective cardiac surgery.
• Frailty was assessed using Fried Scale, Short Physical Performance Battery, Clinical Frailty Scale, and serum albumin.
• Risk prediction was evaluated using the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) and Society of Thoracic Surgeons scores.

Main Results:

• Serum albumin and EuroSCORE II were significantly associated with the primary endpoint of 30-day mortality and major morbidity.
• While a combined EuroSCORE II and albumin model was not significant, adding albumin to EuroSCORE II increased its R-squared value from 0.07 to 0.144.

Conclusions:

• Serum albumin measurement, as a frailty marker, can potentially improve the predictive accuracy of the EuroSCORE II for early postoperative mortality and morbidity in elderly cardiac surgery patients.