Measuring frailty in elderly cardiac surgery patients : a pilot study

Background: As the number of older adults being referred for cardiac surgery in Australia continues to rise, patient frailty is a growing consideration in patient selection. It is felt that frail older adults do not do as well after cardiac surgery and are at greater risk of poorer outcomes. Frailty defined by the Fried criteria [1] remains the best operational definition of frailty but its use in cardiac surgery to date is limited [2]. The purpose of this study was to define frailty using the Fried criteria in our cardiac surgical population and to assess its correlation with post-operative outcomes. Methods: Consecutive patients aged ≥65 years undergoing elective cardiac surgery at The Geelong Hospital were pre-operatively assessed for frailty using the Fried criteria over a 12 month period. The Fried criteria were measured by the physiotherapist and took approximately 10 minutes to complete. Using data collected from the ANZCTS database, we assessed for differences in post-operative mortality and morbidity in frail versus non frail patients. Results: 113 patients were assessed using the Fried criteria with 2 patients not progressing to surgery, leaving a total of 111 patients for analysis. The prevalence of frailty was 15.3% (n = 17). Frail patients were more likely to be female (53%), had a higher prevalence of diabetes, cerebrovascular disease and respiratory disease and a higher NYHA class (median 3 vs. 2). On analysis of early post-operative outcomes, trends toward higher incidences of complications in frail patients were observed: unplanned ICU readmission (12 vs. 1%); re-intubation (12 vs. 3%); cardiac arrest (6 vs. 0%); permanent stroke (6 vs. 0%); prolonged ventilation > 24 hrs (41 vs. 16%); and pneumonia (24 vs. 9%). Median ICU length of stay was longer for the frail patients (44 vs. 27 hrs). There was one in-hospital death in the frail group and none in the non-frail group (6 vs. 0%). The majority of non-frail patients discharged directly home (78%) compared to frail patients (53%). The incidence of 30 day readmission to hospital was also higher in the frail patients (18 vs. 7%). Conclusions: Patients identified as frail by the Fried criteria experience more post-operative complications and are less likely to be discharged directly home from hospital. The Fried criteria can be used to define a group of patients that are at greater risk of poor early outcomes following cardiac surgery.