The Fried Frailty Phenotype in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

Authors

  • Minhtuan Nguyenhuy, MD Western Hospital, Footscray, Melbourne, VIC, Australia
  • Jaewon Chang, MD The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia
  • Ruiwen Xu, BMedsci The University of Melbourne, Parkville, Melbourne, VIC, Australia
  • Sohaib Virk, MD Department of Cardiology, Concord Repatriation General Hospital, Concord West, NSW, Australia
  • Akshat Saxena, MBBS Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Murdoch, WA, Australia

DOI:

https://doi.org/10.1532/hsf.4873

Keywords:

Cardiac Surgery, Frailty, quality of life, outcomes

Abstract

Objective: Frailty is an increasingly recognized marker of poor surgical outcomes in cardiac surgery. Frailty first was described in the seminal “Fried” paper, which constitutes the longest-standing and most well-recognized definition. This study aimed to assess the impact of the Fried and modified Fried frailty classifications on patient outcomes following cardiac surgery.

Methods: The PUBMED, MEDLINE, and EMBASE databases were searched from January 2000 until August 2021 for studies evaluating postoperative outcomes using the Fried or modified Fried frailty indexes in open cardiac surgical procedures. Primary outcomes were one-year survival and postoperative quality of life. Secondary outcomes included postoperative complications, intensive care unit (ICU) length of stay (LOS), total hospital LOS, and institutional discharge.

Results: Eight eligible studies were identified. Meta-analysis identified that frailty was associated with an increased risk of one-year mortality (Risk Ratio [RR]:2.23;95% confidence interval [CI]1.17 -4.23), postoperative complications (RR 1.78;95% CI 1.27 – 2.50), ICU LOS (Mean difference [MD] 21.2 hours;95% CI 8.42 – 33.94), hospital LOS (MD 3.29 days; 95% CI 2.19 – 4.94), and institutional discharge (RR 3.29;95% CI 2.19 – 4.94). A narrative review of quality of life suggested an improvement following surgery, with frail patients demonstrating a greater improvement from baseline over non-frail patients.

Conclusions: Frailty is associated with a higher degree of surgical morbidity, and frail patients are twice as likely to experience mortality within one-year post-operatively. Despite this, quality of life also improves dramatically in frail patients. Frailty, in itself, does not constitute a contraindication to cardiac surgery.

References

Abdullahi YS, Athanasopoulos LV, Casula RP, et al. 2017. Systematic review on the predictive ability of frailty assessment measures in cardiac surgery. Interact Cardiovasc Thorac Surg. 24(4):619-624.

Ad N, Holmes SD, Halpin L, Shuman DJ, Miller CE, Lamont D. 2016. The Effects of Frailty in Patients Undergoing Elective Cardiac Surgery. J Card Surg. 31(4):187-194.

Afilalo J, Lauck S, Kim DH, et al. 2017. Frailty in Older Adults Undergoing Aortic Valve Replacement: The FRAILTY-AVR Study. J Am Coll Cardiol. 70(6):689-700.

Balduzzi S, Rucker G, Schwarzer G. 2019. How to perform a meta-analysis with R: a practical tutorial. Evid Based Ment Health. 22(4):153-160.

Bergman H, Ferrucci L, Guralnik J, et al. 2007. Frailty: an emerging research and clinical paradigm--issues and controversies. J Gerontol A Biol Sci Med Sci. 62(7):731-737.

Bieniek J, Wilczynski K, Szewieczek J. 2016. Fried frailty phenotype assessment components as applied to geriatric inpatients. Clin Interv Aging. 11:453-459.

Brown CHt, Max L, LaFlam A, et al. 2016. The Association Between Preoperative Frailty and Postoperative Delirium After Cardiac Surgery. Anesth Analg. 123(2):430-435.

Chikwe J, Adams DH. 2010. Frailty: the missing element in predicting operative mortality. Seminars in thoracic and cardiovascular surgery. 22(2):109-110.

Fried LP, Tangen CM, Walston J, et al. 2001. Frailty in older adults: evidence for a phenotype. The journals of gerontology Series A, Biological sciences and medical sciences. 56(3):M146-156.

Fulop T, Larbi A, Witkowski JM, et al. 2010. Aging, frailty and age-related diseases. Biogerontology. 11(5):547-563.

Gallagher AM, Lucas R, Cowie MR. 2019. Assessing health-related quality of life in heart failure patients attending an outpatient clinic: a pragmatic approach. ESC Heart Fail. 6(1):3-9.

Gavalaki A, Roussakis A, Zoubourlis P, Contrafouris C, Zarkalis D, Perreas K. 2020. Outcomes and quality of life after aortic valve surgery in octogenarians. J Card Surg. 35(2):341-344.

Gjeilo KH, Stenseth R, Wahba A, Lydersen S, Klepstad P. 2018. Long-term health-related quality of life and survival after cardiac surgery: A prospective study. J Thorac Cardiovasc Surg. 156(6):2183-2190 e2182.

Henry L, Halpin L, Barnett SD, Pritchard G, Sarin E, Speir AM. 2019. Frailty in the Cardiac Surgical Patient: Comparison of Frailty Tools and Associated Outcomes. Ann Thorac Surg. 108(1):16-22.

Higgins JP, Thompson SG, Deeks JJ, Altman DG. 2003. Measuring inconsistency in meta-analyses. BMJ. 327(7414):557-560.

Janssen B, Szende A. 2014. Population Norms for the EQ-5D. In: Szende A, Janssen B, Cabases J, eds. Self-Reported Population Health: An International Perspective based on EQ-5D. Dordrecht (NL). 19-30.

Janssen MF, Szende A, Cabases J, Ramos-Goni JM, Vilagut G, Konig HH. 2019. Population norms for the EQ-5D-3L: a cross-country analysis of population surveys for 20 countries. Eur J Health Econ. 20(2):205-216.

Johnson JA, Coons SJ. 1998. Comparison of the EQ-5D and SF-12 in an adult US sample. Qual Life Res. 7(2):155-166.

Jokinen JJ, Hippelainen MJ, Turpeinen AK, Pitkanen O, Hartikainen JE. 2010. Health-related quality of life after coronary artery bypass grafting: a review of randomized controlled trials. J Card Surg. 25(3):309-317.

Lee JA, Yanagawa B, An KR, et al. 2021. Frailty and pre-frailty in cardiac surgery: a systematic review and meta-analysis of 66,448 patients. J Cardiothorac Surg. 16(1):184.

Li Z, Ding X. 2018. The incremental predictive value of frailty measures in elderly patients undergoing cardiac surgery: A systematic review. Clin Cardiol. 41(8):1103-1110.

Luo D, Wan X, Liu J, Tong T. 2018. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res. 27(6):1785-1805.

Lytwyn J, Stammers AN, Kehler DS, et al. 2017. The impact of frailty on functional survival in patients 1 year after cardiac surgery. J Thorac Cardiovasc Surg. 154(6):1990-1999.

Margulis AV, Pladevall M, Riera-Guardia N, et al. 2014. Quality assessment of observational studies in a drug-safety systematic review, comparison of two tools: the Newcastle-Ottawa Scale and the RTI item bank. Clin Epidemiol. 6:359-368.

McCaffrey N, Kaambwa B, Currow DC, Ratcliffe J. 2016. Health-related quality of life measured using the EQ-5D-5L: South Australian population norms. Health Qual Life Outcomes. 14(1):133.

McCann M, Stamp N, Ngui A, Litton E. 2019. Cardiac Prehabilitation. J Cardiothorac Vasc Anesth. 33(8):2255-2265.

Miguelena-Hycka J, Lopez-Menendez J, Prada PC, et al. 2019. Influence of Preoperative Frailty on Health-Related Quality of Life After Cardiac Surgery. Ann Thorac Surg. 108(1):23-29.

Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. 2009. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med. 3(3):e123-130.

Montgomery CL, Thanh NX, Stelfox HT, et al. 2021. The Impact of Preoperative Frailty on the Clinical and Cost Outcomes of Adult Cardiac Surgery in Alberta, Canada: A Cohort Study. CJC Open. 3(1):54-61.

Pinon M, Paredes E, Acuna B, et al. 2019. Frailty, disability and comorbidity: different domains lead to different effects after surgical aortic valve replacement in elderly patients. Interact Cardiovasc Thorac Surg. 29(3):371-377.

Rumsfeld JS. 2003. Valve surgery in the elderly: question of quality (of life)? J Am Coll Cardiol.42(7):1215-1217.

Sepehri A, Beggs T, Hassan A, et al. 2014. The impact of frailty on outcomes after cardiac surgery: a systematic review. J Thorac Cardiovasc Surg. 148(6):3110-3117.

Shi J, Luo D, Weng H, et al. 2020. Optimally estimating the sample standard deviation from the five-number summary. Res Synth Methods. 11(5):641-654.

Shi S, Afilalo J, Lipsitz LA, et al. 2018. Frailty Phenotype and Deficit Accumulation Frailty Index in Predicting Recovery After Transcatheter and Surgical Aortic Valve Replacement. J Gerontol A Biol Sci Med Sci.

Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument (WHOQOL). 1993. Qual Life Res. 2(2):153-159.

Sundermann SH, Dademasch A, Seifert B, et al. 2014. Frailty is a predictor of short- and mid-term mortality after elective cardiac surgery independently of age. Interact Cardiovasc Thorac Surg. 18(5):580-585.

Theou O, Cann L, Blodgett J, Wallace LM, Brothers TD, Rockwood K. 2015. Modifications to the frailty phenotype criteria: Systematic review of the current literature and investigation of 262 frailty phenotypes in the Survey of Health, Ageing, and Retirement in Europe. Ageing Res Rev. 21:78-94.

Travers J, Romero-Ortuno R, Bailey J, Cooney MT. 2019. Delaying and reversing frailty: a systematic review of primary care interventions. Br J Gen Pract. 69(678):e61-e69.

Wan X, Wang W, Liu J, Tong T. 2014. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 14:135.

Published

2022-09-12

How to Cite

Nguyenhuy, M., Chang, J., Xu , R. ., Virk, S. ., & Saxena, A. (2022). The Fried Frailty Phenotype in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis. The Heart Surgery Forum, 25(5), E652-E659. https://doi.org/10.1532/hsf.4873

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