title: The Effects of Frailty in Patients Undergoing Elective Cardiac Surgery.
abstract: BACKGROUND
  The Society of Thoracic Surgeons (STS) recommends using gait speed as a marker of frailty to identify cardiac surgery patients at risk for adverse outcomes. However, a single marker of frailty may not provide consistently reliable risk information. We evaluated the impact of frailty and gait speed on patient outcomes after elective cardiac surgery.
  
  
  METHODS
  This was a prospective study of 167 older (≥65 years) coronary artery bypass grafting (CABG) and/or valve surgery patients. Patients were assessed using Cardiovascular Health Study (CHS) Frailty Index criteria: weight loss, exhaustion, physical activity, gait speed, and grip strength.
  
  
  RESULTS
  Frailty was identified in 39 patients (23%) using CHS criteria. Frail patients had longer median intensive care unit stays (54 vs. 28 h, p = 0.003), longer median length of stay (8 vs. 5 days, p < 0.001), and greater likelihood of STS-defined complications (54% vs. 32%, p = 0.011) and discharge to an intermediate-care facility (45% vs. 12%, p < 0.001) but were not different from nonfrail patients on major outcome, operative mortality, or readmissions. After multivariate adjustment, frail and nonfrail patients were similar on perioperative outcomes. Absolute gait speed and slow gait speed using a cutoff were not related to incidence of STS-defined complications or major outcome in multivariate analyses. However, higher body mass index was correlated with slower gait speed (rs  = 0.30, p < 0.001).
  
  
  CONCLUSIONS
  The CHS index did not identify "frail" patients at increased risk for adverse outcomes. No relationship was found between gait speed and outcome. There is a need for alternative multidimensional measures to assess frailty in cardiac surgical patients. doi: 10.1111/jocs.12699 (J Card Surg 2016;31:187-194).
authors.affiliation: Department of Cardiac Surgery Research, Inova Heart and Vascular Institute, Falls Church, Virginia.
authors.forename: Niv
authors.initials: N
authors.lastname: Ad
authors.affiliation: Department of Cardiac Surgery Research, Inova Heart and Vascular Institute, Falls Church, Virginia.
authors.forename: Sari D
authors.initials: SD
authors.lastname: Holmes
authors.affiliation: Department of Cardiac Surgery Research, Inova Heart and Vascular Institute, Falls Church, Virginia.
authors.forename: Linda
authors.initials: L
authors.lastname: Halpin
authors.affiliation: Department of Cardiac Surgery Research, Inova Heart and Vascular Institute, Falls Church, Virginia.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Shuman
authors.affiliation: Department of Cardiac Surgery Research, Inova Heart and Vascular Institute, Falls Church, Virginia.
authors.forename: Casey E
authors.initials: CE
authors.lastname: Miller
authors.affiliation: Department of Cardiac Surgery Research, Inova Heart and Vascular Institute, Falls Church, Virginia.
authors.forename: Deborah
authors.initials: D
authors.lastname: Lamont
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D001026:Coronary Artery Bypass; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D016330:Frail Elderly; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012306:Risk; D016896:Treatment Outcome; D000072797:Walking Speed / Q000502:physiology*