• Posted July 6, 2023

Frailty Greatly Lowers Survival in a Surgical Crisis

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.”

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%.

About one in three older frail patients survive, according to the analysis of more than 3,000 patients.

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 authors noted.

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. The team measured frailty using a metric called the Risk Analysis Index, which screens for declines across a patient's bodily functions.

At total of 792 patients were considered frail. Among them, 67% died within 30 days of receiving CPR during surgery.

Of 214 patients considered frail who survived and lived independently prior to surgery, 59% were discharged to nursing homes and rehabilitation facilities.

The findings are an important reminder to doctors about communicating surgical risks to frail patients, no matter how safe a procedure may seem, the study authors pointed out in a hospital news release.

"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.”

Among the reasons for cardiac arrest during surgery include adverse reactions to anesthesia, surgical problems and underlying medical conditions.

It is a physician's job to talk about these risks with patients prior to surgery and to plan for what happens if cardiac arrest does occur. Some patients reverse “Do Not Resuscitate” 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, which can cause rib and sternal fractures that may lead to further complications and slower recovery.

The findings were published online July 3 in JAMA Network Open.

More information

The nonprofit KFF has more on older adults and surgery.

SOURCE: Brigham and Women's Hospital, news release, July 3, 2023