Changes in frailty status after cardiac surgery. A prospective cohort study.

Background During the last years, the concept of frailty has become increasingly familiar in many surgical specialties, including cardiac surgery. One of the main characteristics of frailty is its potentially reversible nature. With the aim of reducing the incidence of complications after surgery, efforts are being made to preoperatively decrease the level of frailty, however, the effect that the surgery itself may have in the postoperative frailty status is still unknown. Methods A prospective cohort of 137 patients aged 70 or more undergoing cardiac surgery with the use of cardiopulmonary bypass were recruited at three university-affiliated hospitals in Spain. Frailty status was assessed preoperatively and six months after surgery using two different validated frailty measurements: The Fried frailty scale and the Clinical Frailty Scale. We analyzed the changes in these frailty scores and the transitions between frailty status after surgery. Results Prevalence of frailty was 27.5% with the Fried Frailty Scale and 11% with the Clinical Frailty Scale. Even though frail patients presented a higher incidence of postoperative major complications than their robust counterparts, up to 50% of frail patients improved their frailty status after surgery. The distribution of frailty groups at baseline and six months after surgery changed significantly, decreasing the overall burden of frailty after surgery. Besides, robust patients showed a slightly worsening of their previous frailty scores. Conclusions Frailty is a multifactorial and dynamic condition that can be significantly reduced after cardiac surgery, suggesting that cardiac pathology is an important contributor to the preoperative patient’s frailty status.

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Activation of kynurenine pathway of tryptophan metabolism after infant cardiac surgery with cardiopulmonary bypass: a prospective cohort study

Metabolomics ◽

10.1007/s11306-020-01714-x ◽

2020 ◽

Vol 16 (9) ◽

Author(s):

Divya Sabapathy ◽

Jelena Klawitter ◽

Lori Silveira ◽

Ludmila Khailova ◽

Max B. Mitchell ◽

...

Keyword(s):

Cardiac Surgery ◽

Cohort Study ◽

Cardiopulmonary Bypass ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Kynurenine Pathway ◽

Tryptophan Metabolism

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CHANGES IN FRAILTY STATUS AFTER CARDIAC SURGERY. A PROSPECTIVE COHORT STUDY

Archives of Gerontology and Geriatrics ◽

10.1016/j.archger.2021.104568 ◽

2021 ◽

pp. 104568

Author(s):

Javier Miguelena-Hycka ◽

Jose Lopez-Menendez ◽

Pablo-Cesar Prada ◽

Miren Martin García ◽

Carlota Vigil-Escalera ◽

...

Keyword(s):

Cardiac Surgery ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Frailty Status

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Effects of Ulinastatin on Postoperative Renal Function in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass: a Prospective Cohort Study

10.21203/rs.3.rs-1049165/v1 ◽

2021 ◽

Author(s):

Hong Lv ◽

Huanran Lv ◽

Yuda Fei ◽

Qian Li ◽

Peng zhang ◽

...

Keyword(s):

Cardiac Surgery ◽

Cohort Study ◽

Cardiopulmonary Bypass ◽

Respiratory Failure ◽

Hospital Mortality ◽

Prospective Cohort ◽

Adverse Outcomes ◽

Control Group ◽

New Onset

Abstract Background: Ulinastatin is a serine protease inhibitor with anti-inflammatory effects. Evidence for the effects of ulinastatin on renal outcomes remains sparse in patients receiving cardiac surgery with cardiopulmonary bypass (CPB).Methods: This prospective cohort study evaluated 413 patients aged 18–70 years who underwent cardiac surgery with CPB, from Aug 2008 to Jul 2019 in Fuwai Hospital, Beijing ,China. The ulinastatin group included 135 patients who received intravenous ulinastatin (1×106 U) after induction of anesthesia. The remaining 278 patients without ulinastatin served as the control group. The primary outcome was the rate of new-onset postoperative acute kidney injury (AKI). The secondary outcome was renal replacement therapy(RRT). Serum creatinine, plasma NGAL, and serum IL-6 levels were evaluated and the CSANGAL Score was calculated. In addition, in-hospital mortality, morbidity, adverse outcomes and 10-year follow-up the survival rate was analyzed.Results: Rate of new-onset AKI was significantly lower in the ulinastatin group than in the control group (20.00% vs. 32.40%, p=0.009). There was no significant difference of RRT between the two groups (0.00% vs. 2.16%, p=0.09). In-hospital mortality, morbidity, and adverse outcomes were comparable between the two groups except for a significantly lower incidence of respiratory failure in the ulinastatin group compared with the control group (0.76% vs. 5.40%, p=0.02). The 10-year follow-up survival rates did not differ significantly between the two groups.Conclusions: Ulinastatin significantly reduced postope rative AKI and respiratory failure in patients receiving cardiac surgery with CPB. But ulinastatin did not reduce ICU and hospital stay and mortality.Clinical trial registration: NCT01060189

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Pre-Operative Frailty Status Is Associated with Cardiac Rehabilitation Completion: A Retrospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm7120560 ◽

2018 ◽

Vol 7 (12) ◽

pp. 560 ◽

Cited By ~ 4

Author(s):

Dustin Kimber ◽

D. Kehler ◽

James Lytwyn ◽

Kevin Boreskie ◽

Patrick Jung ◽

...

Keyword(s):

Cardiac Surgery ◽

Cohort Study ◽

Cardiac Rehabilitation ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Frailty Index ◽

Assessment Tools ◽

Clinical Frailty Scale ◽

Frailty Status ◽

Post Operation

While previous investigations have demonstrated the benefit of cardiac rehabilitation (CR) on outcomes after cardiac surgery, the association between pre-operative frailty and post-operative CR completion is unclear. The purpose of this retrospective cohort study was to determine if pre-operative frailty scores impacted CR completion post-operatively and if CR completion influenced frailty scores in 114 cardiac surgery patients. Frailty was assessed with the use of the Clinical Frailty Scale (CFS), the Modified Fried Criteria (MFC), the Short Physical Performance Battery (SPPB), and the Functional Frailty Index (FFI). A Mann-Whitney test was used to compare frailty scores between CR completers and non-completers and changes in frailty scores from baseline to 1-year post-operation. CR non-completers were more frail than CR completers at pre-operative baseline based on the CFS (p = 0.01), MFC (p < 0.001), SPPB (p = 0.007), and the FFI (p < 0.001). A change in frailty scores from baseline to 1-year post-operation was not detected in either group using any of the four frailty assessments. However, greater improvements from baseline to 1-year post-operation in two MFC domains (cognitive impairment and low physical activity) and the physical domain of the FFI were found in CR completers as compared to CR non-completers. These data suggest that pre-operative frailty assessments have the potential to identify participants who are less likely to attend and complete CR. The data also suggest that frailty assessment tools need further refinement, as physical domains of frailty function appear to be more sensitive to change following CR than other domains of frailty.

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