Combined assessment of low functional capacity and frailty in elective conventional cardiac surgery

Abstract Purpose Functional capacity and frailty represent distinct dimensions of vulnerability in patients undergoing cardiac surgery. While functional capacity is objectively measured, frailty reflects a subjective clinical assessment. Despite their association with adverse outcomes, the prognostic value of their combined assessment remains unclear. To evaluate the association of combined low functional capacity and frailty with post-surgical complications in patients undergoing elective cardiac surgery. Methods This prospective study included adults undergoing elective conventional cardiac surgery. Functional capacity and frailty were evaluated using the Short Physical Performance Battery (SPPB) and Clinical Frailty Scale (CFS), respectively, before surgery (M0) and at discharge (M1). To capture both conditions, participants were categorized according impairment, defined as SPPB ≤ 6 and CFS ≥ 4, and by the difference between the two scores (SPPB – CFS). Outcomes included length of stay in intensive care unit (ICU), duration of mechanical ventilation (MV), hospital length of stay (LOS), postoperative complications, and in-hospital mortality. Results Among 68 participants, 20.6% had low functional capacity and 18.8% were pre-frail or frail. The combined prevalence was 17.6%. Functional capacity declined postoperatively ( p < 0.001). The length of hospital stay and ICU stay was longer in individuals who experienced postoperative complications ( p < 0.001). Among those with complications, 66.7% had both conditions. Individuals with complications had a lower subtraction score (5.5 [1.0-7.2] vs. 7 [5.0–9.0]; p = 0.048). However, no significant association remained in adjusted regression models. Conclusion Combined low functional capacity and frailty were not associated with postoperative complications after elective conventional cardiac surgery.