A Novel Functional Status-Oriented Method for Assessing Operative Risk in Older Patients Undergoing Coronary Artery Bypass Grafting

Abstract

Background. Currently, there is no standardized method for assessing risk before cardiac surgery in older individuals. Recognized operative risk scales do not consider the features of older patients.Aim. To create a scale that can forecast early postoperative outcomes after coronary artery bypass grafting in patients aged over 75 by conducting a comprehensive geriatric assessment.Materials and methods. The study enrolled 83 patients aged 75 and older who required myocardial revascularization, with emergency surgery cases as the exclusion criteria. In addition to the standard screening, all patients underwent comprehensive geriatric assessment, including frailty screening, cognitive assessment, depression screening, grip strength, and short physical performance battery test (walking speed, sit-to-stand performance, standing balance).Results. Six mathematical models predicting coronary artery bypass grafting outcomes were developed: duration of mechanical ventilation (р=0,012), length of stay in intensive care unit (р<0,001), duration of bed rest after surgery (р<0,001), duration of inotropic support (р<0,001), risk of acute cerebrovascular accident (р=0,015), postoperative length of stay (р=0,003). Within Microsoft Excel, mathematical models were used to devise the «Geriatric prognostic scale» for anticipating early postoperative outcomes post coronary artery bypass grafting. To estimate the risk, the following data must be entered: walking speed (m/s), grip strength (kg), sit-to-stand performance (sec), standing balance (sec), total score on the Brief Physical Functioning Test Battery, and total ejection fraction using the Simpson method (%).Conclusion. The developed method allows for the early prediction of outcomes in coronary artery bypass grafting for patients over 75 based on functional status. This is a significant addition to traditional risk scales, which do not consider the features of older patients. The method is straightforward to implement and can be applied independently by the patient's treating physician.