Pre-operative physical performance as a predictor of in-hospital outcomes in older patients undergoing elective cardiac surgery

ObjectiveRisk stratification of cardiac surgery patients is usually based on the Society Thoracic Surgeons (STS) score, that has limited predictive value in older persons. We aimed assessing whether Short Physical Performance Battery (SPPB) improves, beyond STS assessment hospital prognosis undergoing elective surgery.MethodsAll aged 75+ years referred for to Careggi University Hospital (Florence, Italy) from April 2013 March 2017 were evaluated pre-operatively. Participants classified according STS-Predicted Risk Of Mortality (STS-PROM): low (<4%), intermediate (4 8%), and high risk (>8%). Primary study outcomes mortality STS-defined major morbidity. Length stay was an additional outcome.ResultsOut 235 participants (females: 46.5%; mean age: 79.6 years), 144 (61.3%) at low, 67 (28.5%) 24 (10.2%) risk, STS-PROM. SPPB (mean±SEM) 8.8 ± 0.2, 7.0 0.5, 6.0 0.8 intermediate, respectively (p<0.001). The primary outcome occurred 62 (26.4%). In low-risk participants, score predicted endpoint (adjusted OR 0.77, 95% CI 0.66–0.89 per each point increase; p<0.001) controlling STS-Major Morbidity or Operative (STS-MM) score. This result not observed intermediate-high group.ConclusionsSPPB predicts morbidity surgery, as with SPPB, applied preoperatively, might improve surgery.