Evidence map›Paper›PMID 34172059›Full record

SynthesisJournal of cardiothoracic surgery2021

Frailty and pre-frailty in cardiac surgery: a systematic review and meta-analysis of 66,448 patients.

Jessica Avery Lee, Bobby Yanagawa, Kevin R An, Rakesh C Arora, Subodh Verma, Jan O Friedrich, Canadian Cardiovascular Surgery Meta-Analysis Working Group

Registry-linked trialOpen access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of cardiothoracic surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05968456 (Complexity and Frailty in Cardiothoracic and Vascular Anesthesia), which is not on this map. Cited by 67 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
67citing papers in PubMed, 5 pooled it
11.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05968456 unknown statusnot on this mapstarted 2023, after this paper: background citation

Complexity and Frailty in Cardiothoracic and Vascular Anesthesia (CAfCA). Prospective Multicentric Observational Study

TypeobservationalSponsorIstituto Clinico HumanitasRan2023 to 2024Enrolled500ConditionsFrailty, Anesthesia, Thoracic Surgery, Cardiothoracic SurgeryArmsData collection
3 · Its place in the literature

Who cites it

67 citing papers in PubMed, 5 syntheses or guidelines pooled it, 153 citations in OpenAlex.

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7 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 2 countries.

Jessica Avery Lee *Division of Cardiac Surgery, University of Toronto, 30 Bond Street, 8th Floor, Bond Wing, Toronto, ON, M5B 1W8, Canada.ORCID http://orcid.org/0000-0003-4994-4873
Bobby Yanagawa *Division of Cardiac Surgery, University of Toronto, 30 Bond Street, 8th Floor, Bond Wing, Toronto, ON, M5B 1W8, Canada. yanagawab@smh.ca.
Kevin R AnDivision of Cardiac Surgery, University of Toronto, 30 Bond Street, 8th Floor, Bond Wing, Toronto, ON, M5B 1W8, Canada.
Rakesh C AroraDepartment of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Subodh VermaDivision of Cardiac Surgery, University of Toronto, 30 Bond Street, 8th Floor, Bond Wing, Toronto, ON, M5B 1W8, Canada.
Jan O FriedrichCritical Care, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Canadian Cardiovascular Surgery Meta-Analysis Working Group
University of Toronto · CASt. Michael's Hospital · CAUniversity of Manitoba · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe burden of frailty on cardiac surgical outcomes is incompletely understood. Here we perform a systematic review and meta-analysis of studies comparing frail versus pre-frail versus non-frail patients following cardiac surgery.

methodsWe searched MEDLINE and EMBASE databases until July 2018 for studies comparing cardiac surgery outcomes in "frail", "pre-frail" and "non-frail" patients. Data was extracted in duplicate. Primary outcome was operative mortality.

resultsThere were 19 observational studies with 66,448 patients. Frail patients were more likely female (risk ratio [RR]1.7; 95%CI:1.5-1.9), older (mean difference: 2.4; 95%CI:1.3-3.5 years older) with greater comorbidities and higher STS-PROM. Frailty (RR2.35; 95%CI:1.57-3.51; p < 0.0001) and pre-frailty (RR2.03; 95%CI:1.52-2.70; p < 0.00001) were associated with increased operative mortality compared with non-frail patients. Frailty was also associated with greater risk of prolonged hospital stay (RR1.83; 95%CI:1.61-2.08; p < 0.0001) and intermediate care facility discharge (RR2.71; 95%CI:1.45-5.05; p = 0.002). Frail (Hazard Ratio [HR]3.27; 95%CI:1.93-5.55; p < 0.0001) and pre-frail patients (HR2.30; 95%CI:1.29-4.09; p = 0.005) had worse mid-term mortality (median follow-up 1 years [range 0.5-4 years]). After adjustment for baseline imbalances, frailty was still associated with greater operative mortality (odds ratio [OR]1.97; 95%CI:1.51-2.57; p < 0.00001), intermediate care facility discharge (OR4.61; 95%CI:2.78-7.66; p < 0.00001) and midterm mortality (HR1.37; 95%CI:1.03-1.83; p = 0.03).

conclusionIn patients undergoing cardiac surgery, frailty and pre-frailty were associated with 2-fold and 1.5-fold greater adjusted operative mortality, respectively, greater adjusted perioperative complications and frailty was associated with almost 5-fold risk of non-home discharge. Burden of frailty and pre-frailty on cardiac surgical outcomes.

Indexed as

Age FactorsCardiac Surgical ProceduresComorbidityFemaleFrailtyHumansIntraoperative ComplicationsLength of StayMaleOdds RatioPostoperative ComplicationsProportional Hazards ModelsRisk FactorsSex FactorsCoronary artery bypass graftFrailtyValve surgery

Identifiers

PMID34172059
PMCPMC8229742
OpenAlexW3177322038

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.