Frailty significantly reduces survival during a surgical crisis.

Frailty significantly reduces survival during a surgical crisis.

The Impact of Frailty on Survival in Cardiac Arrest During Surgery

When frail patients go into cardiac arrest and need cardiopulmonary resuscitation (CPR) during surgery, they’re more likely to die than those who are stronger, a new study shows. Researchers from Brigham and Women’s Hospital in Boston studied the impact of frailty on survival in these cases where previously frailty was not considered as a factor.

“CPR should not be considered futile for frail patients in the context of surgery,” said lead author Dr. Matt Allen, an attending physician in Brigham’s department of anesthesiology. “But it’s not the case that these patients do just as well as anybody else. In fact, we see a significant association between frailty and mortality.”

The Struggle for Frail Patients

Overall, about 25% of patients who suffer cardiac arrest and receive CPR in a normal hospital setting will survive. For those who get CPR during or in the immediate period following surgery, where they are closely monitored by specialists who know their medical history and can intervene quickly, that number is 50%. However, the study found that only about one in three older frail patients survive, painting a grim picture for this vulnerable group.

Cardiac arrest is the abrupt loss of heart function in a person who may or may not have been diagnosed with heart disease. Frail patients were more likely to die from cardiac arrests that occurred during non-emergency procedures than non-frail individuals, which may mean a higher overall surgery risk for frail patients.

The Study and Its Findings

For the study, the researchers used the American College of Surgeons National Surgical Quality Improvement Program database, which tracks case studies from 700 U.S. hospitals. More than 3,100 patients over 50 years of age received CPR on the day of their surgery between 2015 and 2020.

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Frailty was measured using a metric called the Risk Analysis Index, which screens for declines across a patient’s bodily functions. Among the patients, 792 were considered frail, and 67% of them died within 30 days of receiving CPR during surgery.

Of the 214 patients considered frail who survived and lived independently before surgery, 59% were discharged to nursing homes and rehabilitation facilities. These findings emphasize the importance of doctors communicating surgical risks to frail patients, irrespective of how safe a procedure may seem.

“There’s a shifting paradigm away from focusing on high- or low-risk procedures and instead thinking increasingly about high- or low-risk patients,” Allen said. “This is another example that in frail patients, there is no such thing as a low-risk procedure.”

Understanding Surgical Risks and Potential Complications

It is vital for physicians to discuss the risks associated with surgery with patients beforehand and have a plan in place for dealing with cardiac arrest if it occurs. Some patients even reverse their “Do Not Resuscitate” (DNR) orders for surgeries because the odds of surviving CPR are higher in the operating room.

Frail patients can be particularly vulnerable to the chest compressions involved in CPR, as these compressions can cause rib and sternal fractures, leading to further complications and slower recovery.

Conclusion

The study published in JAMA Network Open serves as a reminder to healthcare professionals about the need to consider frailty when assessing surgical risks. Frail patients face a higher chance of mortality when experiencing cardiac arrest during surgery, highlighting the importance of informed decision-making and open communication between doctors and patients.

By understanding the risks associated with cardiac arrest during surgery, physicians can take proactive measures to minimize patient harm and improve outcomes. It is essential to have comprehensive preoperative evaluations, proper patient education, and tailored treatment plans that account for individual frailty levels.

By focusing on patient-centered care and ensuring frail patients are adequately prepared, healthcare providers can strive to provide the best possible outcomes, despite the challenges posed by cardiac arrest during surgery.

For more information on older adults and surgery, visit the nonprofit KFF website.

Source: Brigham and Women’s Hospital, news release, July 3, 2023