Abstract
Introduction: Guidelines recommend considering patient age when choosing coronary revascularization strategies. However, compared with pre-operative frailty, chronologic age provides limited insight into perioperative risk as the population ages. Hypothesis: In Veterans, pre-operative frailty, independent of age, will influence 5-year mortality after coronary artery bypass grafting surgery (CABG). Methods: Using the validated VA frailty index (VA-FI), we grouped patients into non-frail (0 - 0.1), pre-frail (>0.1 - 0.2), and frail (>0.2) categories. To determine the association between frailty categories and 5-year mortality we fit a multi-level adjusted Cox proportional hazards model using non-frail patients as the referent. We obtained days in hospital (DIH) in the first postoperative year for all groups and compared results with the Wilcoxon test. Results: Among 13,554 patients (2016 - 2020) who underwent CABG (mean age 67 years; 98.5% males, 79% white), 54% 36% and 22% had diabetes mellitus, chronic kidney disease and heart failure respectively. The mean pre-operative VA-FI was 0.21(0.1); 31% were pre-frail and 47% were frail. Frailty prevalence was highest in those <60 years (741/1,416 (52%) compared with 60 - 80 years (2,151/8,735 (25%)) and >80 (79/511 (15%)). The 5-year mortality rate (per 1000 patient-years) was higher in frail patients [54.4 (51.4, 57.7); HR (95% CI) 1.75 (1.54,2.00)] and pre-frail [35 (32.1, 38.3); HR 1.2 (1.08,1.34)] than non-frail patients [27.1 (24, 30.6)]. Compared with non-frail patients (mean 2.7 + 11.6 days), pre-frail (3.9 + 13.9; p < 0.01) and frail (6.3 + 17.6; p < 0.01) spend more days in the hospital in the first post-operative year. Conclusions: Irrespective of age, frailty and pre-frailty were prevalent among US Veterans undergoing CABG and were associated with increased mortality risk and longer hospital length of stay, highlighting the need to evaluate for frailty, even among young patients.
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