DOI: 10.25442/hku.29476730.v1
title: Supporting data for “Unravelling the dynamic patterns of frailty trajectory and factors shaping its changes in patients undergoing coronary artery and/or valve surgery”

description: Frailty is a clinical syndrome characterized by a loss of physiological reserves across multiple organ systems and compromised resilience to stressors. It has emerged as an important prognostic indicator in patients undergoing cardiac surgery, associated with increased mortality, a higher risk of postoperative complications, prolonged hospital stays, and hospital readmissions. Therefore, recognizing and addressing frailty is essential to improving surgical outcomes. Despite robust evidence on the prognostic significance of frailty, limited research has examined frailty trajectories in cardiac surgical patients and the factors shaping their changes over time. Indeed, frailty is a dynamic condition influenced by a multitude of factors. Understanding frailty trajectories is crucial for identifying high-risk populations and determining the optimal timing for interventions. This knowledge informs perioperative care planning and early interventions, thereby reducing the risk of adverse outcomes and preventing further frailty deterioration. Identifying predictors of frailty trajectories also enables the development of individualized interventions targeting modifiable risk factors, ultimately enhancing patient resilience and recovery.This study adopted a mixed methods design, comprising a prospective cohort study aimed to investigate the trajectories of frailty in patients undergoing coronary artery and/or valve surgery and the potential factors influencing frailty changes, and a qualitative study to explore the postoperative recovery experience of patients, focusing on their perceptions of frailty and how they understand, interpret, and adapt to changes and challenges after surgery. A total of 305 adult patients undergoing elective cardiac surgery, including coronary artery bypass grafting (CABG), valve replacement or repair surgeries, and combined CABG and valve surgeries, were recruited from three regional hospitals in Hong Kong. Frailty was measured preoperatively (one day to one week before the scheduled operation), and postoperatively at one, three, and six months. Group-based trajectory modeling identified four distinct groups of frailty trajectory: robust maintained, prefrail improved, prefrail worsened, and frail maintained. Multinomial logistic regression revealed predictors of each trajectory. Higher physical activity level, being overweight, and participation in cardiac rehabilitation after surgery significantly predicted higher odds of frailty improvement. Conversely, higher comorbidity burden, being underweight, kinesiophobia, a threatening illness perception, longer cardiopulmonary bypass duration, postoperative complications, longer hospital stays, and unplanned hospital readmissions were associated with frailty progression or maintaining a frail state. Higher levels of education and cardiac self-efficacy were protective factors against frailty worsening. A subset of 30 patients participated in qualitative interviews at three and six months post-surgery. Thematic analysis identified five themes: the nonlinear recovery journey, fear-driven behavioral adjustments, frailty through a personal lens, deficiencies in postoperative rehabilitation pathways, and psychosocial impacts of surgery. These themes revealed how patients’ perceptions of frailty, along with the physical, emotional, psychosocial, and systemic challenges they encountered, influenced postoperative outcomes.This study is the first to examine frailty trajectories in cardiac surgical patients and the factors influencing them. Findings highlight the dynamic nature of frailty and help informing risk stratification and perioperative care planning. Routine frailty assessments and comprehensive screening for frailty risk factors are recommended to enable early identification and management, ultimately improving patient outcomes.