INTRODUCTION
Frailty is currently considered as a multicausal medical syndrome that is characterized by a diminished strength and endurance. Frailty also implies a reduced physiological reserve, that increases an individual’s vulnerability to develop dependency and/or death after different stress situations (1).
This identification of frailty as an increased vulnerability of adverse health outcomes in community-dwelling adults (2–4) led to the characterization of frailty as an independent risk factor for mortality and morbidity in different medical and surgical scenarios(5–7), including cardiac surgery (8–12).
On the one hand, many studies focused on the utility of frailty to predict adverse events after a surgical procedure (9–12). On the other hand, more recent research has focused on the reversible nature of frailty. In this way, it is generally considered that a decrease in the preoperative frailty status will presumably reduce the incidence of postoperative complications. Therefore, efforts are being made to implement specific physical exercises and pharmacological treatments with the aim to reduce the level of frailty during the preoperative period (13,14). This set of preoperative measures has come to be calledprehabilitation (15–18).
Based also on this dynamic nature of frailty, it would also be interesting to investigate the possibility of changes in frailty status after cardiac surgery. A postoperative improvement in frailty would be expected to the extent that the cardiac pathology was contributing to it. We have recently published that frail patients can improve their quality of life after surgery (19), but postoperative changes in frailty status have not been analyzed. Besides, as a result of the surgical aggression, a postoperative deterioration of the frailty status could also be hypothesized, especially in vulnerable and frail patients. However, there is scarce evidence on this issue and very few studies have addressed it (20,21).
Therefore, the objective of this study was the analysis of the changes of the frailty status that occur six months after a major cardiac surgery with the use of cardiopulmonary bypass.