title: Frailty assessment to predict short term outcomes after cardiac surgery.
abstract: BACKGROUND
  Frailty has been used to predict outcome in gerontology but has only recently been applied to measures of perioperative risk stratification. It provides information on physiological reserve not addressed by current scoring systems which are heavily reliant on age.
  
  
  METHODS
  We enrolled 123 patients over 70-years old (mean age 77.1 years, 69% male) undergoing open cardiac surgery, and assessed in 11 different frailty measures. These were combined into a cumulative score that was stratified into robust (49%), borderline (37%), and frail (14%) groups. The groups were compared for a short-term composite measure comprising mortality, deep sternal wound infection, inter-facility discharge or prolonged length of stay, as well as 3-month mortality and quality of life and 6-month mortality.
  
  
  RESULTS
  Frail patients had a considerably higher incidence of an unfavorable composite outcome (52.9%) compared to their borderline (28.3%) and robust (13.3%) counterparts (p = 0.003). Hospital mortality was 4/123 (3.3%) with a further 3 within 30 days, and 2 late deaths occurred within 6 months postoperatively. This was statistically significant with greater mortality at 6 months in the frail cohort. Quality of life at 3 months showed a trend towards greater improvement in the borderline patients compared to either the robust or frail groups.
  
  
  CONCLUSIONS
  Frailty status impacts on both short- and intermediate-term outcomes, including postoperative quality of life. In an ageing population where nonmaleficence and resource allocation are increasingly important, individual assessment in marginal surgical candidates may provide additional information to both the patient and clinician.
authors.affiliation: Department of Cardiothoracic Surgery, Princess Alexandra Hospital Woolloongabba, Queensland, Australia lachlan_marshall@health.qld.gov.au.
authors.forename: Lachlan
authors.initials: L
authors.lastname: Marshall
authors.affiliation: Department of Cardiothoracic Surgery, Princess Alexandra Hospital Woolloongabba, Queensland, Australia.
authors.forename: Rayleene
authors.initials: R
authors.lastname: Griffin
authors.affiliation: Department of Cardiothoracic Surgery, Princess Alexandra Hospital Woolloongabba, Queensland, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Mundy
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aged; Australia; Cardiac surgical procedures; Frail elderly; Health status indicators; Quality of life