By Lexa W. Lee
NEW ORLEANS -- November 11, 2008 -- Frail elderly patients who have cardiac surgery are at increased risk for postoperative mortality and prolonged care in hospital and nursing facilities, according to results of a retrospective study presented here at the American Heart Association (AHA) Scientific Sessions.
The study was conducted to examine frailty as a functional parameter of biological age and as a subsequent predictor of mortality or prolonged institutional care, according to the lead author of the study, Dana Lee, MD, Dalhousie University, Halifax, Nova Scotia.
Dr. Lee presented the study results on November 10.
Functional measures of frailty and clinical preoperative data were collected for all cardiac surgery patients from 2004 to 2007 at a single centre. Frailty was defined by using the Katz Index of Activities of Daily Living, which examines any impairment in feeding, bathing, dressing, transferring, toileting, continence, ambulation, or dementia.
The researchers used multivariate logistic regression to analyse the influence of patient frailty on in-hospital mortality or institutional discharge, as well as the relationship between frailty and chronological age in the cohort of 3,096 patients.
A total of 133 patients (4.3%) were found to be frail. Non-frail patients aged less than 70 years were used as the control group.
Frail patients were found to be older than the control group; most were female and more likely to have chronic obstructive pulmonary disease, congestive heart failure, ejection fraction less than 40%, recent myocardial infarction, preoperative renal failure, cerebrovascular disease, greater cardiac acuity, and more complex surgeries (P < .05).
The frail group had higher rates of mortality, sepsis, delirium, postoperative renal failure, and transfusion (P < .001) and required subsequent institutional care (49% vs 9%) compared with the control group.
Frail elderly (>=70 years) patients had a greater risk of institutional discharge (odds ratio [OR] 22.7; confidence interval [CI], 12.4-41.7) than frail younger patients (OR 6.5; CI, 3.4-12.5) and non-frail elderly patients (OR 3.5; CI, 2.6-4.6). Frail elderly patients also had a greater risk of mortality (OR 4.0; CI, 1.9-8.1) than the frail younger patients (OR 1.9; CI, 0.8-4.7) and non-frail elderly patients (OR 2.4; CI, 1.7-3.5).
Frailty was found to be an independent predictor of in-hospital mortality (OR 1.8; 95% CI, 1.0-3.2) and discharge to an institution (OR 6.4; 95% CI, 4.1-9.9).
The researchers concluded that frailty combined with older age constituted the highest risk and that special consideration should be given to the management of frail elderly patients who have cardiac surgery.
[Presentation title: Frail Elderly Patients at Increased Risk for Mortality and Prolonged Institutional Care After Cardiac Surgery. Abstract 2301]
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