Multidimensional Frailty Instruments for Cardiac Surgery

Frailty has emerged as an important prognosticator in the field of cardiac surgery. It is more prevalent in patients who undergo cardiac as compared to non-cardiac surgical procedures, and presents unique challenges for clinicians, due to its impact on surgical success and outcomes. With the aging population, and growing complexity of cardiac interventions, the population undergoing cardiac surgery today is increasingly older, multimorbid, and frail. Given these considerations, and the increasing prevalence of severe cardiovascular diseases requiring intervention, routine frailty screening and optimization are crucial to improving outcomes in this high-risk population. To date, the concept of frailty remains poorly recognized and poorly investigated in the context of cardiac surgery. This is primarily attributed to heterogeneity among existing frailty instruments, and its infrequent use as a variable in common cardiac surgery risk scores. In this chapter, we will define frailty in the context of cardiac surgery, the use of perioperative frailty assessment, and provide recommendations for context-specific selection of frailty instruments. By recognizing and addressing frailty in the preoperative assessment and perioperative care of cardiac patients, clinicians will be better able to risk stratify patients, individualize treatment plans, optimize perioperative care, and in doing so, improve outcomes.