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Background <p>Assessment of long-term patient-reported outcome allows identification of vulnerable populations undergoing cardiac surgery. Incorporation of findings into clinical practice may enhance risk-stratification, prevent perioperative complications, and improve outcome. Frailty is prevalent in up to a third of cardiac patients and peri-procedural programs addressing frailty and delirium may be relevant to long-term quality-of-life. This prospective study aims to identify predictors of health-related quality-of-life (HR-QoL) one year after cardiac surgery and assess outcome in patients enrolled in an extensive frailty- and delirium-pathway.</p> Methods <p>Patients undergoing cardiac surgery at a high-volume German heart center were enrolled in an anesthesiology quality registry and health-related quality of life was assessed using the Short Form-12 (SF-12) questionnaire at 1-year-follow-up. Corresponding factors were analyzed for their association with individual outcome. The cohort comprised 812 patients. A subgroup of 190 patients participated in a frailty and delirium management program, providing extended preoperative screening and postoperative supervision.</p> Results <p>Female sex [B -2.59, 95% CI (-4.39 – -0.78), <i>p</i> = 0.005], increase in age [B -3.1, 95% CI (-5.34 – -0.86), <i>p</i> = 0.007] and weight [B -3.97, 95% CI (-6.03 – -1.91), <i>p</i> &lt; 0.001], preoperative anemia [B -3.21, 95% CI (-5.64 – -0.77), <i>p</i> = 0.01], history of smoking [B -3.0, 95% CI (-5.39 – -0.6), <i>p</i> = 0.014], failure to extubate after 8&#xa0;hours of postoperative ventilation [B -1.82, 95% CI (-3.36 – -0.28), <i>p</i> = 0.021], postoperative acute kidney injury [B -2.18 (95% CI -4.22 – -0.14), <i>p</i> = 0.037] and physical frailty [B -9.88, 95% CI (-18.28 – -1.49), <i>p</i> = 0.021] were independently associated with lower physical outcome scores. Cognitive scores were higher in older patients [B 4.08, 95% CI (1.57–6.59), <i>p</i> = 0.001] and lower in smokers [B -2.43, 95% CI (-4.34 – -0.51), <i>p</i> = 0.013].</p> Conclusion <p>Independent predictors of impaired HR-QoL at 1-year follow-up could be identified, suggesting a phenotype at risk. Physical frailty independently predicted poorer physical outcome, emphasizing potential for prehabilitation and frailty-management. Findings should be interpreted considering selection- and response-bias and absence of baseline HR-QoL-assessment.</p> Trial registration <p>This observational study complied with the Declaration of Helsinki and was approved by the Ethics Committee of the Medical Faculty of the Ruhr-University Bochum on 17th November 2022 (Registration-Number: 2022 − 947). Minor additions to the questionnaire were approved on 19th August 2024 (Registration-Number: 2022 − 947_1).</p> Graphical Abstract <p></p>

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Predictors of health-related quality-of-life after cardiac surgery: findings from the ANesthesiology-QUality-Registry (ANQUR) and frailty-management

  • 期刊论文

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  • 发表日期：

    2026年5月25日

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  • Max Briefs,
  • Janis Fliegenschmidt,
  • Jan Wiesemann,
  • Catharina Middeke,
  • Astrid Bergmann,
  • René Schramm,
  • Nikolai Hulde,
  • Jan Gummert,
  • Vera von Dossow

摘要

Background

Assessment of long-term patient-reported outcome allows identification of vulnerable populations undergoing cardiac surgery. Incorporation of findings into clinical practice may enhance risk-stratification, prevent perioperative complications, and improve outcome. Frailty is prevalent in up to a third of cardiac patients and peri-procedural programs addressing frailty and delirium may be relevant to long-term quality-of-life. This prospective study aims to identify predictors of health-related quality-of-life (HR-QoL) one year after cardiac surgery and assess outcome in patients enrolled in an extensive frailty- and delirium-pathway.

Methods

Patients undergoing cardiac surgery at a high-volume German heart center were enrolled in an anesthesiology quality registry and health-related quality of life was assessed using the Short Form-12 (SF-12) questionnaire at 1-year-follow-up. Corresponding factors were analyzed for their association with individual outcome. The cohort comprised 812 patients. A subgroup of 190 patients participated in a frailty and delirium management program, providing extended preoperative screening and postoperative supervision.

Results

Female sex [B -2.59, 95% CI (-4.39 – -0.78), p = 0.005], increase in age [B -3.1, 95% CI (-5.34 – -0.86), p = 0.007] and weight [B -3.97, 95% CI (-6.03 – -1.91), p < 0.001], preoperative anemia [B -3.21, 95% CI (-5.64 – -0.77), p = 0.01], history of smoking [B -3.0, 95% CI (-5.39 – -0.6), p = 0.014], failure to extubate after 8 hours of postoperative ventilation [B -1.82, 95% CI (-3.36 – -0.28), p = 0.021], postoperative acute kidney injury [B -2.18 (95% CI -4.22 – -0.14), p = 0.037] and physical frailty [B -9.88, 95% CI (-18.28 – -1.49), p = 0.021] were independently associated with lower physical outcome scores. Cognitive scores were higher in older patients [B 4.08, 95% CI (1.57–6.59), p = 0.001] and lower in smokers [B -2.43, 95% CI (-4.34 – -0.51), p = 0.013].

Conclusion

Independent predictors of impaired HR-QoL at 1-year follow-up could be identified, suggesting a phenotype at risk. Physical frailty independently predicted poorer physical outcome, emphasizing potential for prehabilitation and frailty-management. Findings should be interpreted considering selection- and response-bias and absence of baseline HR-QoL-assessment.

Trial registration

This observational study complied with the Declaration of Helsinki and was approved by the Ethics Committee of the Medical Faculty of the Ruhr-University Bochum on 17th November 2022 (Registration-Number: 2022 − 947). Minor additions to the questionnaire were approved on 19th August 2024 (Registration-Number: 2022 − 947_1).

Graphical Abstract