Clinical Frailty Scale Assessment Before Cardiac Surgery

The Clinical Frailty Scale (CFS) is a judgement-based scoring system from 1 (very fit) to 9 (terminally ill) that is used to stratify patient frailty based on information from a clinic-based interview and assessment.

CFS scores were assessed from patients undergoing procedures with The Society of Thoracic Surgeons risk models in a statewide collaborative database between January and September 2024. A CFS score ≥5 was considered frail. The associations between CFS scores and postoperative outcomes, existing frailty metrics, and current risk models were evaluated.

Of 3790 patients who underwent CFS assessment, 10.8% were frail. Frail patients were more likely to be women (12.1% vs 9.0% men) and were more likely than nonfrail patients to have chronic medical conditions, including diabetes (56% vs 43.4%) and previous stroke (18.4% vs 8.7%). Operative mortality (4.84% vs 1.79%, P < .001) and major morbidity (17.1% vs 9.5%, P < .001) were more frequent in frail patients relative to nonfrail patients. Addition of CFS to The Society of Thoracic Surgeons predicted risk of mortality model resulted in an incremental increase in C statistic (base model C statistic, 0.789; base model + CFS C statistic, 0.793).

The CFS is a clinic-based system that does not require specialized tools or additional testing. CFS assessment may improve preoperative risk counseling.