FRAILTY ASSESSMENT USING ESTABLISHED DATA REGISTRY IN CARDIAC SURGERY: DEFICIT BASED APPROACH AND IMPACT ON CLINICAL OUTCOMES
CCC ePoster Library. Sarkar S. 10/26/19; 280548; 313
Dr. Shreya Sarkar
Dr. Shreya Sarkar
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Abstract
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BACKGROUND: Elderly patients are incresaingly undergoing cardiac surgery in Canada. This is particularly important as frailty has been shown to have worse short- and long-term outcomes following surgery. To date, little is known about the number of frail patients undergoing cardiac surgery in New Brunswick and the impact that their frailty has on their outcomes. The purpose of this retrospective study was i) to create a registry-based frailty scale to identify patients who were frail and ii) to determine the impact of frailty on in-hospital and 30-day outcomes.

METHODS AND RESULTS: All patients who underwent cardiac surgery at the New Brunswick Heart Centre (NBHC) between 2012- 2017 were included. Patient data was obtained from the NBHC registry. Patients were allocated a frailty score based on 21 equally weighted baseline clinical deficits using independent binary risk variables to create a 21 point scale (Table 1). Patients were segregated into three groups based on their frailty score (low: 0-4, medium: 5-7 and high: ≥8). Comparisons between the three groups were made using chi-square tests for proportions and t-test for continuous variables. 3436 patients were included in the final analysis. The mean age was 66 ± 10 years, 23 % were female, and 61 % underwent isolated CABG. 870 patients had a low frailty score, 1692 a medium frailty score and 874 a high frailty score. Patients with a high frailty score were at higher risk of prolonged hospitalization (median 7 days vs. 5 days; p < 0.001) and failing to be discharged home (49 %, vs. 17 %, p < 0.001) when compared to the lowest frailty score group. 30-day readmission rates were also significantly higher (18 % vs. 10 %, p < 0.001) in the high frailty score group when compared to the lowest Furthermore, increasing frailty scores were associated with a significant increase in 30- day mortality (low: 0.7 %,, medium: 1.2 % and high: 4.7 %; p < 0.001).

CONCLUSION: The study demonstrates that a deficit-based approach may be used to identify the most vulnerable patients undergoing heart surgery. Using this approach we were able to determine a deficit or frailty score that correlated directly with the likelihood of patients requiring prolonged hospitalization, failing to be discharged home and survival at 30 days. The present study provides the rationale for using this approach to study interventions aimed at our most vulnerable who suffer from the frailty syndrome and impact their transition home.
BACKGROUND: Elderly patients are incresaingly undergoing cardiac surgery in Canada. This is particularly important as frailty has been shown to have worse short- and long-term outcomes following surgery. To date, little is known about the number of frail patients undergoing cardiac surgery in New Brunswick and the impact that their frailty has on their outcomes. The purpose of this retrospective study was i) to create a registry-based frailty scale to identify patients who were frail and ii) to determine the impact of frailty on in-hospital and 30-day outcomes.

METHODS AND RESULTS: All patients who underwent cardiac surgery at the New Brunswick Heart Centre (NBHC) between 2012- 2017 were included. Patient data was obtained from the NBHC registry. Patients were allocated a frailty score based on 21 equally weighted baseline clinical deficits using independent binary risk variables to create a 21 point scale (Table 1). Patients were segregated into three groups based on their frailty score (low: 0-4, medium: 5-7 and high: ≥8). Comparisons between the three groups were made using chi-square tests for proportions and t-test for continuous variables. 3436 patients were included in the final analysis. The mean age was 66 ± 10 years, 23 % were female, and 61 % underwent isolated CABG. 870 patients had a low frailty score, 1692 a medium frailty score and 874 a high frailty score. Patients with a high frailty score were at higher risk of prolonged hospitalization (median 7 days vs. 5 days; p < 0.001) and failing to be discharged home (49 %, vs. 17 %, p < 0.001) when compared to the lowest frailty score group. 30-day readmission rates were also significantly higher (18 % vs. 10 %, p < 0.001) in the high frailty score group when compared to the lowest Furthermore, increasing frailty scores were associated with a significant increase in 30- day mortality (low: 0.7 %,, medium: 1.2 % and high: 4.7 %; p < 0.001).

CONCLUSION: The study demonstrates that a deficit-based approach may be used to identify the most vulnerable patients undergoing heart surgery. Using this approach we were able to determine a deficit or frailty score that correlated directly with the likelihood of patients requiring prolonged hospitalization, failing to be discharged home and survival at 30 days. The present study provides the rationale for using this approach to study interventions aimed at our most vulnerable who suffer from the frailty syndrome and impact their transition home.
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