Aim: Increasingly elderly patients are being offered surgical treatments for cardiac diseases. The objective of this study was to assess the association between the Edmonton Frailty Scale (EFS) score and its nine domains in determining mortality risk, discharge destination, risk of prolonged Intensive Care Unit (ICU) and hospital stays, and post-operative complications in elderly cardiothoracic surgical patients.
Methods: This retrospective, observational, cohort study assessed individuals aged ≥70 years, living independently, who were planned for major elective cardiothoracic surgery. The primary outcomes were death and discharge destination (assessed using binary logistic regression modelling). The secondary outcomes included length of ICU and hospital stays, and complications (assessed using negative binomial regression modelling).
Results: This study assessed 117 non-frail, 33 vulnerable, 9 mildly and 4 moderately frail patients. There was a statistically significant association between 30-day mortality and the Frailty Domain: Mood (Odds Ratio = 0.07, p = 0.034). For every 1-point increase in the General Health Status Score, the odds of being discharged home at the end of the acute hospital stay decreased by 30% (p = 0.037). For every 1-point increase in the General Health Status score, the odds of being discharged to inpatient rehabilitation increased by 45% (p = 0.029). An answer of ‘yes’ to the question regarding weight loss in the antecedent period to the patient’s operation led to a 4-fold increased chance of being discharged home by 30 days post-operative (p = 0.045). In relation to being located in inpatient rehabilitation at 30 days post-operative, an answer of ‘yes’ to weight loss in the lead-up to the operation was associated with a 13% chance of this outcome (p = 0.031). In relation to secondary outcomes, significant findings were demonstrated related to length of hospital and ICU stays, urinary tract infections, and delirium risk, related to multiple EFS domains.
Conclusions: The EFS and its domains are predictive of several adverse outcomes post cardiothoracic surgery including increased rates of infection, delirium, prolonged ICU, and extended hospital stays. Incorporating this tool into the preoperative workup of older individuals offers the opportunity to provide a more balanced risk assessment and improved decision making.