Impact of Frailty Risk on Adverse Outcomes after Open Heart Valve Surgery in Older Patients: A Retrospective Cohort Study.

Abstract

Objectives: This study aimed to investigate the impact of preoperative frailty risk, assessed using the Hospital Frailty Risk Score (HFRS), on hospitalization-associated disability (HAD) and in-hospital complications in patients aged 65 years or older who underwent open heart valve surgery.

Methods: This retrospective cohort study included patients in the JMDC database aged 65 years or older with valvular heart disease who underwent open heart valve surgery between April 2017 and December 2022. Patients were categorized into low (HFRS <5) and high frailty risk (HFRS ≥5) groups. The primary outcome was the proportion of patients with HAD. The secondary outcomes included the proportion of patients who developed pneumonia, respiratory failure, and delirium during hospitalization. Mediation analysis was performed to examine whether preoperative frailty risk influenced the risk of HAD through postoperative complications.

Results: Among 4658 patients (mean age 75.0 ± 5.5 years), 328 (7.0%) were classified as high frailty risk. The high risk group had a significantly higher proportion of HAD than the low risk group [odds ratio (OR), 3.49; 95% confidence interval (CI), 2.60-4.67; P <0.001]. Mediation analysis showed that high frailty risk was independently associated with HAD (direct effect: OR, 2.75; 95% CI, 2.01-3.76; P <0.001). The indirect effect mediated by postoperative complications was significant (OR, 1.26; 95% CI, 1.11-1.43; P <0.05), accounting for 19% of the total effect.

Conclusions: The preoperative frailty risk assessed by the HFRS may serve as a useful predictor of HAD and in-hospital complications in older patients undergoing open heart valve surgery.