Frailty and postoperative functional outcome Preoperative evaluation in elderly cardiac surgery patients: Preoperative evaluation in elderly cardiac surgery patients

Patients presenting for cardiac surgery are ageing. Older patients often have multiple chronic diseases and may be frail. Frailty is a biological syndrome characterised by a loss of functional reserves across multiple organ systems. It may limit physical, mental, and social functioning. The prevalence differs and symptoms can range from no impairments at all to an accumulation of deficits. Examples of frailty characteristics are weight loss, decreased muscle strength, cognitive problems or reduced gait speed. Frailty has become an established risk factor for postsurgical complications. Its use as a predictor for patient centred outcomes is not yet clear. However, preoperative informed consent and treatment decisions are dependent on accurate risk prediction.

The primary aim of this thesis was to assess the associations of frailty characteristics with functional outcomes after cardiac surgery in elderly patients. The main results show a high prevalence of frailty characteristics, especially on the physical domain (for example, decreased gait speed or grip strength). However, there was a low prevalence of severe frailty. Patients with more frailty characteristics are more likely to experience worse health related quality of life or disabilities one year after cardiac surgery. Frailty can be used in selecting high risk patients for preoperative multidisciplinary team care. These results support recent guidelines that recommend a preoperative assessment of frailty in elderly patients. Frailty has a clinical use in terms of risk assessment, to identify potentially modifiable risk factors, clinical decision making, and preoperative patient counselling.