Preoperative Physical Frailty Assessment among Octogenarians Undergoing Cardiac Surgery: Upgrading the “Eyeball” Test

Abstract Objectives There are many well-described, but as yet unproven, physical ability tools to assess frailty. Methods Between 2016-2019, 200 patients ≥80 years undergoing elective cardiac surgery were prospectively recruited. Four physical tests were performed preoperatively: the 5-meter walk test (5MWT), the timed up-and-go test (TUG), the 5-time sit-to-stand test (5STS), and the handgrip strength test (HGS). The primary endpoint was a composite of in-hospital mortality, neurologic, and pulmonary complications; multivariate analysis was performed. Results In-hospital mortality was 1.5%. Slow performance on the 5MWT (time≥ 6.4 seconds) was the only independent predictor of the composite endpoint among the tests evaluated (OR 2.70; 95% CI 1.34-5.45; p=0.006). At follow-up, patients with a slow 5MWT had a significantly lower mid-term survival compared to patients with a normal test (1-year survival 91.5% vs. 98.7%, log-rank p=0.03). Mean physical and mental component scores of the SF-12 were 47.2±8.3 and 53.6±5.9 respectively, which are comparable to those of a general population>75 years old. Conclusion The 5-meter walk time test is an independent predictor of a composite of in-hospital mortality and major morbidity, as well as mid-term survival. This test could be used as a simple adjunctive preoperative tool for octogenarians undergoing cardiac surgery.