The Use of Frailty Scoring to Predict Early Physical Activity Levels After Cardiac Surgery.

BACKGROUND: Assessing patient fitness prior to high-risk operations is becoming increasingly vital in cardiothoracic surgery. Physical activity (PA) and frailty measures are powerful perioperative tools, albeit underused in clinical practice. This study aimed to assess the influence of patient frailty on PA postsurgery and other short-term outcomes. METHODS: Eighty patients undergoing a variety of cardiac surgical procedures (coronary revascularisation, valve repair/replacement, or combination) were recruited to participate. The Reported Edmonton Frailty Scale was used to measure preoperative frailty. As objective measures of PA, participants wore a wrist accelerometer device for 14 days prior to their operation and early in the postoperative period for 30 days. RESULTS: A global reduction in PA was observed in the early postoperative period. Frailty was a significant predictor of reduced light (coefficient -2.23, 95% CI -4.21 to -0.25, P = .028) and moderate activity (coefficient -1.85, 95% CI -2.99 to -0.70, P = .002) postoperatively. Neither frailty nor preoperative PA were predictors of postoperative composite complications. Both frailty (coefficient 0.134, 95% CI 0.106-0.162, P < .001) and PA scores (P < .05) were strong predictors of length of hospital stay (coefficient 1.76, 95% CI 0.003-3.524, P = .05). Furthermore, patients who stayed in hospital longer were more likely to suffer early postoperative complications (stroke, renal failure, reoperation, pacemaker) if they were frail (P < .0001) compared to non-frail patients (P = .607). CONCLUSIONS: This study highlights the predictive ability of objective frailty scoring and PA measurement for outcomes after cardiac surgery. This has important implications for surgical risk stratification and personalized postoperative planning.

A technical review of subvalvular techniques for repair of ischaemic mitral regurgitation and their associated echocardiographic and survival outcomes.

Subvalvular techniques are gaining ground as adjunct procedures for addressing ischaemic mitral regurgitation. The aim of this study was to describe the different techniques and assess their results. A systematic review of the literature was performed. The end points of interest were recurrence of mitral regurgitation, cardiac events and early and late echocardiographic measurements. After initial screening, 450 articles were identified, of which 24 provided the best available evidence on the topic. The different subvalvular techniques had similar mortality rates when compared with the standard restrictive annuloplasty. Recurrence of mitral regurgitation was of lower degree and the remodelling process was better for these techniques. Reoperation rates were also quite low. The subvalvular techniques showed superiority, addressing more successfully the leaflet tethering. However, larger randomized studies are needed to confirm these early positive results.

Systematic review on the predictive ability of frailty assessment measures in cardiac surgery.

Objectives: Patient frailty is increasingly recognised as contributing to adverse postoperative outcomes in cardiothoracic surgery. The goal of this review is to evaluate the predictive ability of frailty scoring systems and their limitations in risk assessment of patients undergoing cardiac surgery. Methods: Frailty studies were identified by searching electronic databases. Studies in which the measuring instrument was defined as a multidimensional tool focusing on a population undergoing cardiac operations were included. The focus was on the predictive ability of frailty in this population and a comparison with conventional risk scoring systems. Unfortunately, the lack of a significant number of studies with the same postoperative outcome precluded a formal meta-analysis. Results: Of 783 studies identified in our initial search, 6 fulfilled our inclusion criteria. Frailty was identified as a predictor of mortality, morbidity and/or prolonged hospital stay in patients undergoing cardiac surgery. Our systematic review revealed the increased application of frailty scores compared to standardized risk stratification scores in cardiothoracic patients. In approximately 50% of these studies, frailty scores continued to be predictive even after adjusting for the conventional risk scoring systems. Conclusions: The assessment of frailty may enhance the preoperative workup and offer an optimized risk stratification measure in patients undergoing cardiothoracic procedures even though the reporting standards of calibration and classification measures have been relatively poor.