Advertisement
Pro and Con|Articles in Press

Con: can we influence postoperative outcomes of frail patients after cardiac surgery?

Published:March 07, 2023DOI:https://doi.org/10.1053/j.jvca.2023.03.003

      Summary

      Frail patients are routinely scheduled for elective cardiovascular surgery. Despite proven association between frailty and postoperative outcomes, currently we have no consistent evidence that preoperative optimisation of frail patients with preoperative nutrition support and exercise programs can alter post-operative mortality. Established frailty diagnostic tools are not sufficient to grasp the multidimensional nature of frailty in cardiovascular patients. Prehabilitation programs and preoperative nutritional support are time and resource consuming and therefore hard to implement in routine clinical practice.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Cardiothoracic and Vascular Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Fawzy AM
        • Lakhani H
        • Wyrko Z.
        Frailty Assessment in patients undergoing cardiovascular interventions: a quality improvement project.
        Age Ageing. 2019; 48: i1-i15
        • Yanagawa B
        • Graham MM
        • Afilalo J
        • et al.
        Frailty as a risk predictor in cardiac surgery: beyond the eyeball test.
        J Thorac Cardiovasc Surg. 2018; 156 (e2): 172-176
        • Afilalo J
        • Alexander KP
        • Mack MJ
        • et al.
        Frailty assessment in the cardiovascular care of older adults.
        J Am Coll Cardiol. 2014; 63: 747-762
        • Goldfarb M
        • Lauck S
        • Webb JG
        • et al.
        Malnutrition and Mortality in Frail and Non-Frail Older Adults Undergoing Aortic Valve Replacement.
        Circulation. 2018; 138: 2202-2211
        • Stoppe C
        • Goetzenich A
        • Whitman G
        • et al.
        Role of nutrition support in adult cardiac surgery: a consensus statement from an International Multidisciplinary Expert Group on Nutrition in Cardiac Surgery.
        Crit Care. 2017; 21: 131
        • Svetikiene M
        • Ringaitiene D
        • Vezeliene J
        • et al.
        The efficacy of early postoperative enteral immunonutrition on T-lymphocyte count: A randomised control study in low-risk cardiac surgery patients.
        Clin Nutr. 2021; 40: 372-379
        • Lee ZY
        • Hasan MS
        • Day AG
        • et al.
        Initial development and validation of a novel nutrition risk, sarcopenia, and frailty assessment tool in mechanically ventilated critically ill patients: The NUTRIC-SF score.
        JPEN J Parenter Enteral Nutr. 2022; 46: 499-507
        • Stoppe C
        • McDonald B
        • Meybohm P
        • et al.
        Effect of High-Dose Selenium on Postoperative Organ Dysfunction and Mortality in Cardiac Surgery Patients.
        The SUSTAIN CSX Randomized Clinical Trial. JAMA Surgery, 2023 (in press)
        • Tew GA
        • Ayyash R
        • Durrand J
        • et al.
        Clinical guideline and recommendations on pre-operative exercise training in patients awaiting major non-cardiac surgery.
        Anaesthesia. 2018; 73: 750-768
        • Rosenfeldt F
        • Braun L
        • Spitzer O
        • et al.
        Physical conditioning and mental stress reduction - a randomised trial in patients undergoing cardiac surgery.
        BMC Complement Altern Med. 2011; 11: 20
        • Herdy AH
        • Marcchi PL
        • Vila A
        • et al.
        Pre- and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery: a randomized controlled trial.
        Am J Phys Med Rehabil. 2008; 87: 714-719
        • Arthur HM
        • Daniels C
        • McKelvie R
        • et al.
        Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery. A randomized controlled trial.
        Ann Intern Med. 2000; 133: 253-262
        • Hulzebos EH
        • Smit Y
        • Helders PP
        • et al.
        Preoperative physical therapy for elective cardiac surgery patients.
        Cochrane Database Syst Rev. 2012; 11CD010118
        • Snowdon D
        • Haines TP
        • Skinner EH.
        Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review.
        J Physiother. 2014; 60: 66-77
        • Waite I
        • Deshpande R
        • Baghai M
        • et al.
        Home-based preoperative rehabilitation (prehab) to improve physical function and reduce hospi-tal length of stay for frail patients undergoing coronary artery bypass graft and valve surgery.
        J Cardiothorac Surg. 2017; 12: 91
        • Norris CM
        • Close JCT.
        Prehabilitation for the Frailty Syndrome: Improving Outcomes for Our Most Vulnerable Patients.
        Anesth Analg. 2020; 130: 1524-1533
        • Lee JA
        • Yanagawa B
        • An KR
        • et al.
        Canadian Cardiovascular Surgery Meta-Analysis Working Group. Frailty and pre-frailty in cardiac surgery: a systematic review and meta-analysis of 66,448 patients.
        J Cardiothorac Surg. 2021; 16: 184
      1. Sandhu MS, Akowuah EF. Does prehabilitation improve outcomes in cardiac surgical patients? Interact Cardiovasc Thorac Surg. 201; 29(4): 608-611.

        • McCann M
        • Stamp N
        • Ngui A
        • et al.
        Cardiac Prehabilitation.
        J Cardiothorac Vasc Anesth. 2019; 33: 2255-2265