Nutrition and frailty status of patients undergoing cardiovascular surgery and its association with postoperative outcomes

Abstract

Background: Malnutrition is a component of Frailty Syndrome characterized by weakness, poor nutritional status and reduced cognitive function. Frailty has been recognized to adversely affect post Cardiovascular Surgery outcomes in the elderly. In developing countries, Frailty can occur in younger patients from Rheumatic Heart Disease and earlier onset of Atherosclerotic Cardiovascular Disease. There is limited data on frailty in the young. Methods: Malnutrition and Frailty were assessed preoperatively in 111 adult patients undergoing Cardiovascular Surgery from October 2020 to February 2021. Nutrition Risk Screening Tool (NRS) and Clinical Frailty Scale (CFS) were used for assessment respectively. Their in-hospital postoperative outcomes was then observed. Results: There were 57 patients (51%) diagnosed with malnutrition, 26 (23%) of which were also Frail. Advanced age, Rheumatic Heart Disease, Heart Failure and Chronic Kidney Disease was significantly higher in malnutrition and frail group. After multivariate analysis, mortality rate (odds ratio [OR] 7.8; 95% confidence interval [CI]: 1.45 - 41.91; P=.017), prolonged hospitalization (OR: 5.96; 95% CI: 2.14-16.53; P=.001), mechanical ventilation (OR: 7.56; 95% CI: 1.81-31.62; P=.006) and nosocomial infections (OR: 13.57; 95% CI: 4.41-41.76; P≤.001) were found higher in patients with malnutrition and frailty. Conclusion: Evaluation of nutrition and frailty status using NRS and CFS was helpful in predicting postoperative outcomes. With a significant number of this population having Malnutrition and Frailty, there is a need to strengthen clinical pathways on perioperative nutrition and rehabilitation with the possibility of improving Cardiovascular Surgery outcomes.