The impact of frailty on postoperative complications and resource utilization in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI).

Abstract

Patients with severe aortic stenosis undergoing transcatheter aortic valve implantation are usually older adults with multiple comorbidities and often frail. Frailty reflects increased vulnerability to adverse outcomes and is an important factor in this population; however, its impact on postoperative complications and healthcare resource utilization remains uncertain. We investigated the association between preoperative frailty and postoperative outcomes using a nationwide electronic medical records database in Japan. We included patients aged 65 years or older who underwent transcatheter aortic valve implantation between April 2013 and December 2021. Frailty was assessed with the Hospital Frailty Risk Score, with a score of 5 or higher indicating frailty. The primary outcome was acute kidney injury within seven days. Secondary outcomes included major adverse kidney events, blood transfusion within 30 days, and hospital length of stay. Among 781 patients, 237 (30.3%) were classified as frail. Acute kidney injury occurred in 8.8% of non-frail and 12.7% of frail patients. After adjustment for age, sex, comorbidities, baseline estimated glomerular filtration rate, surgical approach, anesthesia type, and hospital size, the odds ratio for acute kidney injury in frail patients was 1.42 (95% confidence interval, 0.83-2.45; P = 0.20). Hospital stay was significantly longer in frail patients, with an adjusted mean difference of 3.45 days. Preoperative frailty was not significantly associated with acute kidney injury or other complications but was associated with prolonged hospitalization. Frailty screening before transcatheter aortic valve implantation may help identify patients at risk of extended hospital stay and guide perioperative care.