Does Frailty Help Predict Postoperative Outcomes in Cardiac Surgery?

Study Overview
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Brief Summary
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This study will assess the benefit in using a frailty score to quantify accurate risk pre-operatively in patients undergoing major cardiac surgery in order to predict morbidity and disability-free survival post-operatively.

Detailed Description
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Increasingly, the group of patients undergoing cardiac surgery are older. Patients that are more elderly and frail are known to have an increase risk of injury to major organs following surgery including the heart, kidneys, and brain, all of which are associated with worse survival or diminished quality of life. It is becoming more important to be able to predict how well patients will fair in cardiac surgery, including predicting risk of complications (such as stroke or heart attacks) as well as long-term survival and quality of life. Currently, scores such as EUROscore can be used with good effect in predicting survival and major complications in cardiac surgery patients. However, frailty - the severity of a patient's weakness or fragility - has emerged as a potential candidate in predicting risk. Recent research has shown frailty score to predict risk of survival and complications following cardiac surgery and suggested to be possibly superior to pre-existing scores. The investigators wish to investigate the possible link between frailty and outcomes following cardiac surgery, in addition to current risk scores. The investigators also wish to determine whether frailty can effectively predict longer-term outcomes such as 'disability-free survival' - a patient-centred score that measures the ability of a patient to lead normal life activities. Patients undergoing major cardiac surgery at King's College Hospital will be recruited, following consent. The study will mainly involve questionnaires at various stages, starting at a pre-operative clinic. After surgery, follow up of patient's progress will be carried out at 3 days in hospital; and at 1 month, 3 months, and 6 months and 1 year via telephone. The investigators expect the results of this observational study to influence further research into the use of frailty risk scoring prior to clinical decisions, and add to the evidence in assessing risk-related outcomes in cardiac surgery.

Official Title
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Assessment of the Frailty Score in Cardiac Surgery and Its Correlation to Cardiac Postoperative Morbidity and Disability - a Prospective Observational Study

Conditions
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Coronary Heart Disease, Heart Valve Diseases

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged 18 years or over Due to undergo elective cardiac surgery: coronary artery bypass graft (CABG); valve replacement/repair; or transcatheter aortic valve implantation (TAVI) surgery Able to give informed consent Fluency in English Exclusion Criteria: Emergency cardiac surgery and non-cardiac surgery Inadequate knowledge of English that will prevent patients from completing the consent or undertaking study assessments Severe visual, auditory, or motor handicap Concurrent diseases of the central nervous system, Patients at the extremes of frailty, in whom it would be unethical to perform a full assessment.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Cardiac Surgery<br>Patients undergoing cardiac surgery: coronary artery bypass graft (CABG); valve replacement/repair; or transcatheter aortic valve implantation (TAVI) surgery | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Disability-free survival | Defined as percentage of participants alive and with a disability score (using World Health Organisation Disability Assessment Schedule 2.0, WHODAS) of less than 25%. | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality |  | 1 month postoperative | 
| Delirium | Using Confusion Assessment Method (CAM). | 3 days postoperative | 
| In hospital complications | Incidence of major adverse cardiac or cerebrovascular events, and/or acute renal injury. | 1 month | 
| Return to theatre |  | 1 month | 
| Length of hospital stay |  | 1 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cardiac, Surgery, Frailty, Frail, Patients, Recovery, Morbidity, Outcomes, Mortality, Heart, Perioperative, Disability, WHODAS