ArticleJournal of the American Geriatrics Society2023
Preoperative frailty and adverse outcomes following coronary artery bypass grafting surgery in US veterans.
Article in Journal of the American Geriatrics Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
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Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 16 citations in OpenAlex.
- Impact of frailty on outcomes following coronary artery bypass grafting: a systematic review and meta-analysis.BMC surgery · 2024Pooled it
- Prevalence and Impact of Frailty in Pancreatic Cancer: A Systematic Review and Meta-Analysis Based on 35,191 Patients.Annals of surgical oncology · 2024Pooled it
- Frailty, age, and treatment effect of surgical coronary revascularization in ischemic cardiomyopathy: a post hoc analysis of the STICHES trial.GeroScience · 2025Trial
- Association of serum lactate and one-year mortality among women with coronary artery bypass grafting surgery: filling gaps in female.Journal of cardiothoracic surgery · 2026Article
- The impact of frailty on postoperative outcomes of veterans with stage I non-small cell lung cancer.Surgery · 2026Article
- Evaluating Frailty Index Integrity: Insights from an International Network Study.medRxiv : the preprint server for health sciences · 2026Article
- Unmasking frailty in coronary artery disease: impact on outcomes after lower limb amputation.Journal of geriatric cardiology : JGC · 2025Article
- Patients with dementia or frailty undergoing major limb amputation have poor outcomes.Journal of vascular surgery · 2025Article
- Frailty: An Underappreciated Risk Factor for IBD Complications.Current gastroenterology reports · 2024Review
- The perioperative frailty index derived from the Chinese hospital information system: a validation study.BMC geriatrics · 2024Article
- Frailty and Cardiovascular Health.Journal of the American Heart Association · 2024Review
- Pharmacotherapy for Coronary Artery Disease and Acute Coronary Syndrome in the Aging Population.Current atherosclerosis reports · 2024Review
- Chronological vs Biological Age in Interventional Cardiology: A Comprehensive Approach to Care for Older Adults: JACC Family Series.JACC. Cardiovascular interventions · 2024Review
- Frailty efficacy as a predictor of clinical and cognitive complications in patients undergoing coronary artery bypass grafting: a prospective cohort study.BMC cardiovascular disorders · 2024Article
Corrections and comments
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Authors and funding
12 authors at 9 institutions in 2 countries.
Funding
Abstract
backgroundContemporary guidelines emphasize the value of incorporating frailty into clinical decision-making regarding revascularization strategies for coronary artery disease. Yet, there are limited data describing the association between frailty and longer-term mortality among coronary artery bypass grafting (CABG) patients.
methodsWe conducted a retrospective cohort study (2016-2020, 40 VA medical centers) of US veterans nationwide that underwent coronary artery bypass grafting (CABG). Frailty was quantified by the Veterans Administration Frailty Index (VA-FI), which applies the cumulative deficit method to render a proportion of 30 pertinent diagnosis codes. Patients were classified as non-frail (VA-FI ≤ 0.1), pre-frail (0.1 < VA-FI ≤ 0.2), or frail (VA-FI > 0.2). We used Cox proportional hazards models to ascertain the association of frailty with all-cause mortality. Our primary study outcome was 5-year all-cause mortality; the co-primary outcome was days alive and out of the hospital within the first postoperative year.
resultsThere were 13,554 CABG patients (median 69 years, 79% White, 1.5% women). The mean pre-operative VA-FI was 0.21 (SD: 0.11); 31% were pre-frail (VA-FI: 0.17) and 47% were frail (VA-FI: 0.31). Frail patients were older and had higher co-morbidity burdens than pre-frail and non-frail patients. Compared with non-frail patients (13.0% [11.4, 14.7]), there was a significant association between frail and pre-frail patients and increased cumulative 5-year all-cause mortality (frail: 24.8% [23.3, 26.1]; HR: 1.75 [95% CI 1.54, 2.00]; pre-frail 16.8% [95% CI 15.3, 18.4]; HR 1.2 [1.08,1.34]). Compared with non-frail patients (mean 362[SD 12]), pre-frail (mean 361 [SD 14]; p < 0.01) and frail patients (mean 358[SD 18]; p < 0.01) spent fewer days alive and out of the hospital in the first postoperative year.
conclusionsPre-frailty and frailty were prevalent among US veterans undergoing CABG and associated with worse mid-term outcomes. Given the high prevalence of frailty with attendant adverse outcomes, there may be an opportunity to improve outcomes by identifying and mitigating frailty before surgery.
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