Dataset Information

Preoperative frailty and adverse outcomes following coronary artery bypass grafting surgery in US veterans.

ABSTRACT:

Background

Contemporary guidelines emphasize the value of incorporating frailty into clinical decision-making regarding revascularization strategies for coronary artery disease. Yet, there are limited data describing the association between frailty and longer-term mortality among coronary artery bypass grafting (CABG) patients.

Methods

We conducted a retrospective cohort study (2016-2020, 40 VA medical centers) of US veterans nationwide that underwent coronary artery bypass grafting (CABG). Frailty was quantified by the Veterans Administration Frailty Index (VA-FI), which applies the cumulative deficit method to render a proportion of 30 pertinent diagnosis codes. Patients were classified as non-frail (VA-FI ≤ 0.1), pre-frail (0.1 < VA-FI ≤ 0.2), or frail (VA-FI > 0.2). We used Cox proportional hazards models to ascertain the association of frailty with all-cause mortality. Our primary study outcome was 5-year all-cause mortality; the co-primary outcome was days alive and out of the hospital within the first postoperative year.

Results

There were 13,554 CABG patients (median 69 years, 79% White, 1.5% women). The mean pre-operative VA-FI was 0.21 (SD: 0.11); 31% were pre-frail (VA-FI: 0.17) and 47% were frail (VA-FI: 0.31). Frail patients were older and had higher co-morbidity burdens than pre-frail and non-frail patients. Compared with non-frail patients (13.0% [11.4, 14.7]), there was a significant association between frail and pre-frail patients and increased cumulative 5-year all-cause mortality (frail: 24.8% [23.3, 26.1]; HR: 1.75 [95% CI 1.54, 2.00]; pre-frail 16.8% [95% CI 15.3, 18.4]; HR 1.2 [1.08,1.34]). Compared with non-frail patients (mean 362[SD 12]), pre-frail (mean 361 [SD 14]; p < 0.01) and frail patients (mean 358[SD 18]; p < 0.01) spent fewer days alive and out of the hospital in the first postoperative year.

Conclusions

Pre-frailty and frailty were prevalent among US veterans undergoing CABG and associated with worse mid-term outcomes. Given the high prevalence of frailty with attendant adverse outcomes, there may be an opportunity to improve outcomes by identifying and mitigating frailty before surgery.

SUBMITTER: Kochar A

PROVIDER: S-EPMC10524307 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

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Publications

Preoperative frailty and adverse outcomes following coronary artery bypass grafting surgery in US veterans.

Kochar Ajar A Deo Salil V SV Charest Brian B Peterman-Rocha Fanny F Elgudin Yakov Y Chu Danny D Yeh Robert W RW Rao Sunil V SV Kim Dae H DH Driver Jane A JA Hall Daniel E DE Orkaby Ariela R AR

Journal of the American Geriatrics Society 20230421 9

<h4>Background</h4>Contemporary guidelines emphasize the value of incorporating frailty into clinical decision-making regarding revascularization strategies for coronary artery disease. Yet, there are limited data describing the association between frailty and longer-term mortality among coronary artery bypass grafting (CABG) patients.<h4>Methods</h4>We conducted a retrospective cohort study (2016-2020, 40 VA medical centers) of US veterans nationwide that underwent coronary artery bypass grafti ...[more]

PMID: 37083188

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Project description:AimsCombined coronary artery bypass grafting (CABG) and aortic valve replacement (AVR), and female sex are associated with increased perioperative mortality in clinical risk scores. This study investigated male-female differences in short-term outcome stratified by age groups.Methods and resultsAll patients undergoing AVR and CABG between January 2001 and June 2021 at our institution were included. 1963 patients were grouped by decades into: 59 years and younger (n = 127), 60-69 (n = 471), 70-79 (n = 1070), and 80 years and older (n = 295). The primary end points of this study were 30 and 180 days mortality. Secondary end points were influence of preoperative risk factors and impact of sex on survival and postoperative major adverse events. Female patients showed higher 30 and 180 days mortality after combined CABG and AVR surgery (8.3% vs. 4.2%, P < 0.01; 15.8% vs. 9.4%, P < 0.01). Stratified by age groups, 30 and 180 days mortality remained significantly higher in septuagenarians (9.6% vs. 2.5%, P < 0.01; 16.3% vs. 7.7%, P < 0.01). Females were significantly older, had better preserved left ventricular function, and higher incidence of diabetes mellitus compared with male patients in this subgroup (P < 0.01; P = 0.01; P < 0.01). Additionally, females received significantly less internal mammary artery (IMA) conduits (P < 0.01). Female sex (OR: 3.33, 95% CI: [1.76-6.31]; 1.93, [1.22-3.06]), higher age (1.28, [1.13-1.45]; 1.16, [1.06-1.26]), diabetes mellitus (1.93, [1.03-3.60]; 1.70, [1.08-2.67]) and LVEF <30% (3.26, [1.48-7.17]; 2.23, [1.24-4.02]) were correlated with 30 and 180 days mortality, respectively. Upon multivariable testing, sex (1.77, [1.21-2.58]) and LVEF <30% (3.71, [2.39-5.76]) remained independent predictors for major adverse postoperative events. Infrequent use of IMA grafts was associated with increased 30 and 180 days mortality as well as adverse events (0.47, [0.25-0.87]; 0.46, [0.29-0.72]; 0.61, [0.42-0.88]).ConclusionsSex disparities in baseline characteristics may delay operative intervention in female patients. The inherent risk profiles might be responsible for outcome differences in septuagenarians.

Project description:BackgroundCoronary artery bypass grafting (CABG) remains the preferred treatment for complex multi-vessel coronary artery disease, offering substantial long-term benefits. Non-cardiac comorbidities such as frailty may significantly affect the outcomes of this procedure. However, the exact impact of frailty on CABG outcomes remains unclear, particularly given its exclusion from many pivotal revascularization trials. This systematic review and meta-analysis aimed to consolidate existing data to evaluate the impact of frailty on short- and long-term outcomes following CABG.MethodsSearches across PubMed, Cochrane Library, Embase, and Scopus were done to identify studies that were published up to March 31, 2024, had detailed preoperative frailty assessments and compared frail versus non-frail adult patients undergoing CABG. Primary outcomes were all-cause mortality and major adverse cardiac events within one year. Secondary outcomes included hospital readmission rates and length of stay. A random-effects model was used to account for heterogeneity. Results were reported as odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI).ResultsOur meta-analysis, involving data from 14 studies, revealed a significant increase in both 30-day (OR 2.52; 95% CI: 2.07 to 3.07) and 1-year mortality (OR 2.58; 95% CI: 1.49 to 4.45) among frail patients. The risk of acute cardiac and cerebrovascular complications was comparable in all patients (OR 1.03; 95% CI: 0.89 to 1.19). However, frailty was associated with a significant increase in the risk of acute kidney injury (OR 2.31; 95% CI: 1.26 to 4.23). Frail patients were more likely to have longer hospital stays and higher readmission rates compared to their non-frail counterparts.ConclusionOur study confirms the critical impact of frailty on mortality and morbidity in CABG patients and advocates for the integration of frailty assessments into the preoperative evaluation process. Addressing frailty can lead to more individualized patient care and better outcomes, urging a paradigm shift towards comprehensive, patient-centric management in cardiac surgery.Prospero registerCRD42024521327.

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Dataset Information

Preoperative frailty and adverse outcomes following coronary artery bypass grafting surgery in US veterans.

Background

Methods

Results

Conclusions

Publications

Preoperative frailty and adverse outcomes following coronary artery bypass grafting surgery in US veterans.

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