Influence of Preoperative Frailty On Health-Related Quality of Life after Cardiac Surgery

Abstract Background Frailty has emerged as one of the main predictors of worse outcomes after cardiac surgery, but scarce evidence is available about its influence on postoperative quality-of-life. Whether frail patients may improve their quality-of-life or not after the surgical procedure is a matter that still remains unclear. Methods Observational and multicenter cohort study, conducted in three university-affiliated hospitals of three different regions of Spain (Madrid, Asturias and Canary Islands). Patients were categorized into three ordinal levels of frailty (frail, pre-frail, robust) using three different frailty scales (Fried, FRAIL scale, Clinical Frailty Scale). We analyzed the changes on health-related quality-of-life for each level of frailty using the EuroQoL-5D-5L questionnaire prior and 6 months after surgery. Results A total of 137 patients were included, and 109 patients completed the 6-month follow-up. Median age of the entire cohort was 78 years (IQI:72-83 years). Frailty prevalence varied between 10% and 29%, depending on which scale was employed. There was a statistically significant linear trend in the incidence of mortality or major morbidity among the different levels of frailty. During follow-up, robust patients did not show significant changes in their previously high score of quality-of-life. On the other hand, frail and pre-frail patients significantly improved their scores after surgery. These results were comparable regardless the scale used for frailty assessment. Conclusions Frail and pre-frail patients have a significant improvement in their quality-of-life 6 months after cardiac surgery, and they have a proportionally greater increase in their postoperative health-related quality of life scores than robust ones.