Utility of A Comprehensive Risk Assessment for Elective Cardiovascular Surgery

抄録

Objective: To evaluate the utility of a comprehensive risk assessment system for cardiovascular surgery.
Materials and methods: Among 438 patients who underwent elective cardiovascular surgery between 2020 and 2021, 199 underwent a comprehensive preoperative risk assessment using the Japanese version of the Cardiovascular Health Study (J-CHS) criteria, Short Physical Performance Battery (SPPB), Mini-Mental State Examination (MMSE), and Barthel Index. The patients were divided into 3 groups according to the J-CHS classification: robust (n = 50), prefrail (n = 110), and frail (n = 39). The in-hospital mortality, transfer to rehabilitation, and length of hospital stay were compared between the groups. Predictors of in-hospital mortality or transfer for rehabilitation were identified using a multivariate analysis.
Results: The J-CHS class correlated with other risk assessment tools (all p < 0.001). Male sex (robust vs. prefrail vs. frail; median: 74% vs. 54.5% vs. 38.5%), albumin concentration (4.0 vs. 4.0 vs. 3.6 g/dL), and hemoglobin concentration (12.9 vs. 12.7 vs. 11.4 g/dL) were significantly different between the groups (p < 0.01), while age was not. Transfer for rehabilitation (6% vs. 9.1% vs. 23.1%, p = 0.038) and hospital stay (15 vs. 16 vs. 22 days, p < 0.001) were significantly different between the groups, whereas the in-hospital mortality was not markedly different. An MMSE score of < 4 points (odds ratio [OR] 4.67, p = 0.029) and SPPB score of < 9 points (OR 3.66, p = 0.032) predicted in-hospital mortality and transfer for rehabilitation.
Conclusion: The length of hospital stay and transfer for rehabilitation increased in the J-CHS frailty group. The SPPB and MMSE scores may predict in-hospital outcomes in older patients.