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Association of preoperative frailty with pulmonary complications after cardiac surgery in elderly individuals: a prospective cohort study

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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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References

  1. Miskovic A, Lumb AB (2017) Postoperative pulmonary complications. Br J Anaesth 118:317–334

    Article  CAS  PubMed  Google Scholar 

  2. Fischer MO, Brotons F, Briant AR et al (2022) Postoperative Pulmonary Complications After Cardiac Surgery: The VENICE International Cohort Study. J Cardiothorac Vasc Anesth 36:2344–2351

    Article  PubMed  Google Scholar 

  3. Weissman C (2004) Pulmonary complications after cardiac surgery. Semin Cardiothorac Vasc Anesth 8:185–211

    Article  PubMed  Google Scholar 

  4. Kuplay H, Bayer Erdogan S, Bastopcu M et al (2021) Performance of the EuroSCORE II and the STS score for cardiac surgery in octogenarians. Turk Gogus Kalp Damar Cerrahisi Derg 29:174–182

    Article  PubMed  PubMed Central  Google Scholar 

  5. Nashef SA, Roques F, Sharples L et al (2012) EuroSCORE II. Eur J Cardiothorac Surg 41:734–744

    Article  PubMed  Google Scholar 

  6. Cruz-Jentoft AJ, Kiesswetter E, Drey M et al (2017) Nutrition, frailty, and sarcopenia. Aging Clin Exp Res 29:43–48

    Article  PubMed  Google Scholar 

  7. Dent E, Martin FC, Bergman H et al (2019) Management of frailty: opportunities, challenges, and future directions. Lancet 394:1376–1386

    Article  PubMed  Google Scholar 

  8. Milne B, Lucas de Carvalho J, Ayis S et al (2022) Frailty and perioperative patient-reported disability in patients undergoing cardiac surgery: a pilot study. Br J Anaesth 128:949–958

    Article  PubMed  PubMed Central  Google Scholar 

  9. Afilalo J, Mottillo S, Eisenberg MJ et al (2012) Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcome 5:222e8

    Article  Google Scholar 

  10. Sündermann S, Dademasch A, Rastan A et al (2011) One-year follow-up of patients undergoing elective cardiac surgery assessed with the comprehensive assessment of frailty test and its simplified form. Interact Cardiovasc Thorac Surg 13:119–123. https://doi.org/10.1510/icvts.2010.251884

    Article  PubMed  Google Scholar 

  11. Jung P, Pereira MA, Hiebert B et al (2015) The impact of frailty on postoperative delirium in cardiac surgery patients. J Thorac Cardiovasc Surg 149:869-875.e862. https://doi.org/10.1016/j.jtcvs.2014.10.118

    Article  PubMed  Google Scholar 

  12. Culver BH, Graham BL, Coates AL et al (2017) ATS Committee on Proficiency Standards for Pulmonary Function Laboratories: Recommendations for a standardized pulmonary function report An official American Thoracic Society technical statement. Am J Respir Crit Care Med 196:1463–1472

    Article  PubMed  Google Scholar 

  13. Hulzebos EH, Helders PJ, Favié NJ et al (2006) Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA 296:1851–1857. https://doi.org/10.1001/jama.296.15.1851

    Article  CAS  PubMed  Google Scholar 

  14. Lagier D, Fischer F, Fornier W et al (2019) Effect of open-lung vs conventional perioperative ventilation strategies on postoperative pulmonary complications after on-pump cardiac surgery: the PROVECS randomized clinical trial. Intensive Care Med 45:1401–1412

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Riley RD, Ensor J, Snell KIE et al (2020) Calculating the sample size required for developing a clinical prediction model. BMJ 368:m441. https://doi.org/10.1136/bmj.m441

    Article  PubMed  Google Scholar 

  16. Salim TI, Nestlerode LC, Lucatorto EL et al (2020) Frailty as tested by gait speed is a risk factor for liver transplant respiratory complications. Am J Gastroenterol 115:859–866

    Article  PubMed  Google Scholar 

  17. Chen D, Ding Y, Zhu W et al (2022) Frailty is an independent risk factor for postoperative pulmonary complications in elderly patients undergoing video-assisted thoracoscopic pulmonary resections. Aging Clin Exp Res 34:819–826. https://doi.org/10.1007/s40520-021-01988-8

    Article  PubMed  Google Scholar 

  18. Khanna AK, Kelava M, Ahuja S et al (2021) A nomogram to predict postoperative pulmonary complications after cardiothoracic surgery. J Thorac Cardiovasc Surg. https://doi.org/10.1016/j.jtcvs.2021.08.034

    Article  PubMed  Google Scholar 

  19. Alam M, Shehzad MI, Hussain S et al (2020) Spirometry Assessment and Correlation With Postoperative Pulmonary Complications in Cardiac Surgery Patients. Cureus 12:e11105. https://doi.org/10.7759/cureus.11105

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lagan AL, Melley DD, Evans TW et al (2008) Pathogenesis of the systemic inflammatory syndrome and acute lung injury: role of iron mobilization and decompartmentalization. Am J Physiol Lung Cell Mol Physiol 294:L161–L174

    Article  CAS  PubMed  Google Scholar 

  21. Levy JH, Tanaka KA (2003) Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 75:S715–S720

    Article  PubMed  Google Scholar 

  22. Ji Q, Mei Y, Wang X et al (2013) Risk factors for pulmonary complications following cardiac surgery with cardiopulmonary bypass. Int J Med Sci 10:1578–1583. https://doi.org/10.7150/ijms.6904

    Article  PubMed  PubMed Central  Google Scholar 

  23. Faubel S (2008) Pulmonary complications after acute kidney injury. Adv Chronic Kidney Dis 15:284–296. https://doi.org/10.1053/j.ackd.2008.04.008

    Article  PubMed  Google Scholar 

  24. Covarrubias J, Grigorian A, Schubl S (2021) Obesity associated with increased postoperative pulmonary complications and mortality after trauma laparotomy. Eur J Trauma Emerg Surg 47:1561–1568. https://doi.org/10.1007/s00068-020-01329-w

    Article  PubMed  Google Scholar 

  25. Pelosi P, Gregoretti C (2010) Perioperative management of obese patients. Best Pract Res Clin Anaesthesiol 24:211–225. https://doi.org/10.1016/j.bpa.2010.02.001

    Article  PubMed  Google Scholar 

  26. Kulkarni SR, Fletcher E, McConnell AK et al (2010) Pre-operative inspiratory muscle training preserves postoperative inspiratory muscle strength following major abdominal surgery - a randomised pilot study. Ann R Coll Surg Engl 92:700–707. https://doi.org/10.1308/003588410X12771863936648

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Snowdon D, Haines TP, Skinner EH (2014) Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review. J Physiother 60:66–77. https://doi.org/10.1016/j.jphys.2014.04.002

    Article  PubMed  Google Scholar 

  28. Akdogan A, Erturk E, Ozdemir AC et al (2022) The effect of thoracic epidural analgesia on short-term outcome and mortality in geriatric patients undergoing open heart surgery. Ulus Travma Acil CerrahiDerg 28:382–389

    Google Scholar 

  29. Treschan TA, Malbouisson LM, Beiderlinden M (2015) Intraoperative mechanical ventilation strategies to prevent postoperative pulmonary complications in patients with pulmonary and extrapulmonary comorbidities. Best Pract Res Clin Anaesthesiol 29:341–355. https://doi.org/10.1016/j.bpa.2015.08.002

    Article  PubMed  Google Scholar 

  30. Waite I, Deshpande R, Baghai M et al (2017) Home-based preoperative rehabilitation (prehab) to improve physical function and reduce hospital length of stay for frail patients undergoing coronary artery bypass graft and valve surgery(J). J Cardiothorac Surg 12:91. https://doi.org/10.1186/s13019-017-0655-8

    Article  PubMed  PubMed Central  Google Scholar 

  31. Laghlam D, Naudin C, Srour A (2023) Persistent diaphragm dysfunction after cardiac surgery is associated with adverse respiratory outcomes: a prospective observational ultrasound study. Can J Anaesth 70:228–236. https://doi.org/10.1007/s12630-022-02360-8

    Article  PubMed  Google Scholar 

  32. Soma D, Kawamura YI, Yamashita S et al (2020) Association between sarcopenia and pneumonia in older people. Geriatr Gerontol Int 20:7–13. https://doi.org/10.1093/dote/doy092

    Article  Google Scholar 

  33. Soysal P, Stubbs B, Lucato P et al (2022) Inflammation and frailty in the elderly: A systematic review and meta-analysis. Ageing Res Rev 31:1–8. https://doi.org/10.1016/j.arr.2016.08.006

    Article  CAS  Google Scholar 

  34. Abbatecola AM, Paolisso G (2008) Is there a relationship between insulin resistance and frailty syndrome? Curr Pharm Des 14:405–410

    Article  CAS  PubMed  Google Scholar 

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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).

Author information

Author notes

  1. Guanglei Fan and Shuyang Fu have contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, NO.99 Huaihai West Road, Xuzhou, 221006, People’s Republic of China

    Guanglei Fan, Shuyang Fu, Mingzhu Zheng, Wei Xu, Fengran Zhang, Mingyue Li & Xiangjun Liu

  2. Department of Intensive Care Medicine, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai West Road, Xuzhou City, 221006, People’s Republic of China

    Wenjing Zhao

  3. Department of Anesthesiology, Nanjing University of Chinese Medicine Affiliated Hospital, 155 Hanzhong Road Qinhuai District, Nanjing, 210004, People’s Republic of China

    Guangyu Ma

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  1. Guanglei Fan
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  3. Mingzhu Zheng
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  4. Wei Xu
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Corresponding author

Correspondence to Wenjing Zhao.

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Human and animal rights

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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Informed consent was obtained from all individual participants included in this study.

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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

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