Exploring the association of frailty and swallowing function with postoperative changes in activities of daily living among older patients undergoing cardiac surgery

BACKGROUND: Postoperative decline in activities of daily living (ADL) is common among older patients undergoing cardiac surgery and is associated with poor quality of life and adverse clinical outcomes. Frailty and lower swallowing function have each been linked to postoperative functional decline; however, their combined association with postoperative ADL recovery remains unclear. OBJECTIVES: This retrospective cohort study examined the association between the coexistence of frailty and lower swallowing function and postoperative functional outcomes in older adults undergoing cardiac surgery. METHODS: A total of 123 patients (median age, 73 years; 71.5% male) who underwent elective cardiac surgery between July 2020 and August 2024 were included. The primary outcome was the change in Barthel Index (BI) score from preoperative assessment to hospital discharge. Frailty was assessed using the Japanese version of the Cardiovascular Health Study (J‑CHS) criteria, and swallowing function was evaluated with the Repetitive Saliva Swallowing Test (RSST). Participants were classified into four groups according to the presence or absence of frailty and lower swallowing function (RSST ≤ 4). RESULTS: The mean change in BI score was -2.03 ± 6.68, and those with both frailty and lower swallowing function exhibited a greater BI decline than the other groups (p < 0.001). After adjustment for demographic and clinical variables, the coexistence of frailty and lower swallowing function remained independently associated with BI change (β = -0.371, p < 0.001). CONCLUSIONS: These findings indicate that frailty and lower swallowing function may be meaningful factors associated with postoperative functional decline in older adults undergoing cardiac surgery, emphasizing the potential value of comprehensive preoperative assessment and multidisciplinary management strategies.