Preoperative Frailty Assessment and Outcomes at 6 Months or Later in Older Adults Undergoing Cardiac Surgical Procedures: A Systematic Review

Abstract

Background: Frailty assessment may inform surgical risk and prognosis not captured by conventional surgical risk scores.

Purpose: To evaluate the evidence for various frailty instruments used to predict mortality, functional status, or major adverse cardiovascular and cerebrovascular events (MACCEs) in older adults undergoing cardiac surgical procedures.

Data sources: MEDLINE and EMBASE (without language restrictions), from their inception to 2 May 2016.

Study selection: Cohort studies evaluating the association between frailty and mortality or functional status at 6 months or later in patients aged 60 years or older undergoing major or minimally invasive cardiac surgical procedures.

Data extraction: 2 reviewers independently extracted study data and assessed study quality.

Data synthesis: Mobility, disability, and nutrition were frequently assessed domains of frailty in both types of procedures. In patients undergoing major procedures (n = 18 388; 8 studies), 9 frailty instruments were evaluated. There was moderate-quality evidence to assess mobility or disability and very-low- to low-quality evidence for using a multicomponent instrument to predict mortality or MACCEs. No studies examined functional status. In patients undergoing minimally invasive procedures (n = 5177; 17 studies), 13 frailty instruments were evaluated. There was moderate- to high-quality evidence for assessing mobility to predict mortality or functional status. Several multicomponent instruments predicted mortality, functional status, or MACCEs, but the quality of evidence was low to moderate. Multicomponent instruments that measure different frailty domains seemed to outperform single-component ones.

Limitation: Heterogeneity of frailty assessment, limited generalizability of multicomponent frailty instruments, few validated frailty instruments, and potential publication bias.

Conclusion: Frailty status, assessed by mobility, disability, and nutritional status, may predict mortality at 6 months or later after major cardiac surgical procedures and functional decline after minimally invasive cardiac surgery.

Primary funding source: National Institute on Aging and National Heart, Lung, and Blood Institute.

Figures

Figure 1. Frailty Assessment in Cardiac Surgical Procedures*

Abbreviations: AVR, aortic valve replacement; CABG, coronary artery bypass grafting; FU, follow-up; m, month; NA, not applicable; NR, not reported; STS, Society of Thoracic Surgeons predicted risk of mortality; TAVR, transcatheter aortic valve replacement * Open circle indicates information obtained from self-report or medical records; solid circle indicates information obtained from performance tests. Prevalence of frailty was determined according to the study-specific definition. † Administration time was reported by the authors. ‡ Administration time includes explaining the test, performing the test, and allowing the patient to recover according to a clinical trial protocol.