Análise combinada entre capacidade funcional e fragilidade no desenvolvimento de complicações pós-cirúrgicas em cirurgia cardíaca eletiva convencional

Abstract

The surgical approach is the main therapeutic strategy for various cardiovascular diseases. Low functional capacity and frailty can contribute to negative outcomes. Therefore, early screening of these conditions may help mitigate postoperative complications. This study aimed to evaluate the association of low functional capacity and frailty combined with the development of postoperative complications in patients undergoing elective conventional cardiac surgery. This is a prospective, longitudinal study conducted at a private hospital. Individuals of both sexes, aged ≥18 years, and indicated for elective conventional cardiac surgery were included. Participants were evaluated before surgery (M0) and at hospital discharge (M1). Functional capacity was assessed using the Short Physical Performance Battery (SPPB), and frailty was assessed using the Clinical Frailty Scale (CFS). Additionally, we created a score calculated by subtracting the SPPB test score from the CFS scale score. The individuals were monitored throughout the hospitalization period, and data on the development of postoperative complications, length of hospital stay, and mortality were recorded. For statistical analysis, three logistic regression models were created: the crude or unadjusted model, model 1 including variables with statistical significance (p<0.05) in the bivariate analysis, and the adjusted model 2 with variables identified through Backward adjustment. As results, this study evaluated 68 participants with a mean age of 60.4±11.7 years, 53.2% of whom were men. At M0, 20.6% had low functional capacity, while 18.8% were classified as pre-frail or frail. The prevalence of combined low functional capacity and frailty was 17.6%. The prevalence of postoperative complications was 32.4%. Among patients with postoperative complications, 66.7% had low functional capacity and were pre-frail or frail. Patients who developed complications had a lower SPPB - CFS subtraction score compared to those without complications (5.5 [1.0-7.2] vs. 7 [5.0-9.0], p=0.048). However, the combination of low functional capacity and frailty was not associated with postoperative complications in the logistic regression analysis. In conclusion, the combination of low functional capacity and frailty was not associated with postoperative complications, although patients with complications had a lower score derived from these two conditions.