Frailty in Cardiac Surgery-Assessment Tools, Impact on Outcomes, and Optimisation Strategies: A Narrative Review

Area of Science:

• Cardiology
• Geriatrics
• Surgical Care

Background:

• Cardiac surgery is increasingly performed on older, frailer patients.
• Frailty is a key prognostic indicator influencing post-operative recovery and outcomes.
• Optimizing care for frail cardiac surgery patients requires specific strategies.

Purpose of the Study:

• Identify frailty assessment tools for cardiac surgery patients.
• Evaluate the impact of frailty on post-operative outcomes.
• Explore strategies to optimize care for frail patients undergoing cardiac surgery.

Main Methods:

• Comprehensive literature search across PubMed, MEDLINE, and SCOPUS.
• Identification of studies reporting post-operative outcomes in frail cardiac surgery patients.

Main Results:

• Validated frailty assessment tools include gait speed, Clinical Frailty Scale, Fried frailty phenotype, deficit accumulation frailty index, and Short Physical Performance Battery.
• Frailty is associated with increased post-operative morbidity, mortality, ICU/hospital stays, and delirium.
• Perioperative optimization strategies include pre-operative nutritional support, prehabilitation, geriatric assessment, and post-operative delirium management, nutrition, rehabilitation, and occupational therapy.

Conclusions:

• Early perioperative identification of frailty is essential for risk stratification.
• Tailored management strategies are necessary to minimize frailty's impact on cardiac surgery outcomes.