Abstract
Background
The relationship between preoperative frailty and pulmonary complications after cardiac surgery in elderly patients is unclear. This study was designed to evaluate the relationship between frailty and postoperative pulmonary complications (PPCs) in elderly patients undergoing cardiac surgery and to provide a basis for their prevention and treatment.
Aims
This study aimed to investigate the predictive value of preoperative frailty on pulmonary complications after cardiac surgery in elderly patients.
Methods
Frailty was assessed using the CAF. The diagnosis of PPCs was based on the criteria defined by Hulzebos et al., and patients were classified into a PPCs group and a non-PPCs group. Factors with clinical significance and P < 0.05 in univariate regression analysis were included in multivariate logistic regression analysis to determine the relationship between preoperative frailty and PPCs. The area under the receiver operating characteristic (ROC) curve (AUC) was used to compare the predictive effects of the CAF, EuroSCORE II, and ASA + age on the occurrence of PPCs.
Results
A total of 205 patients were enrolled in this study, 31.7% of whom developed PPCs. Univariate logistic regression analysis showed that frailty, ASA grade, EuroSCORE II, hemoglobin concentration, FVC, time of operation, and postoperative AKI were associated with the development of PPCs. However, after adjustments for all possible confounding factors, multivariate logistic regression results showed that frailty, prolonged operation time, and postoperative AKI were risk factors for PPCs, and the risk of postoperative PPCs in frail patients was approximately 4.37 times that in nonfrail patients (OR = 4.37, 95%CI: 1.6–11.94, P < 0.05). The predictive efficacy of the traditional perioperative risk assessment tools EuroSCORE II and ASA + age was lower than that of CAF.
Conclusions
Frailty before surgery, prolonged operation time, and postoperative AKI were independent risk factors for pulmonary complications after heart surgery in elderly individuals, and CAF was more effective than the traditional risk predictors EuroSCORE II and ASA + age.
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Funding
This study was supported by the Jiangsu Province Six Talent Peak Category D Fund Project and the Xuzhou Science and Technology Bureau of Jiangsu Province (No. 2015059 and No.KC16SY150).
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This study was approved by the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University (no. XYFY2022-KL300-01). The study procedures were also in accordance with these principles.
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Fan, G., Fu, S., Zheng, M. et al. Association of preoperative frailty with pulmonary complications after cardiac surgery in elderly individuals: a prospective cohort study. Aging Clin Exp Res 35, 2453–2462 (2023). https://doi.org/10.1007/s40520-023-02527-3
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DOI: https://doi.org/10.1007/s40520-023-02527-3