Abstract
Background
Although multidimensional frailty scales have been proven to predict mortality and
morbidity in cardiac surgery, there is a need for rapid tools that could be easily
administered at the point of care. Handgrip strength (HGS) is an attractive option
that can be measured in acutely ill and bed-bound patients, although it has yet to
be validated in a large cardiac surgery cohort.
Methods
This is a post hoc analysis of a multicentre prospective study in older patients undergoing
coronary artery bypass grafting and/or valve surgery from 2011 to 2019. HGS was measured
before surgery and classified by sex-stratified cutoffs. The primary outcome was 1-year
mortality and secondary outcomes were 30-day mortality, discharge disposition, and
prolonged length of stay.
Results
There were 1245 patients included in the analysis (mean age 74.0 ± 6.6 years; 30%
female). Weak HGS was associated with advanced age, heart failure, kidney disease,
malnutrition, and various frailty scales. In those with weak vs normal HGS, respectively,
1-year mortality was 17% vs 6%, 30-day mortality was 10% vs 3%, prolonged length of
stay was 34% vs 19%, and discharge to a health care facility was 45% vs 26% (all P < 0.001). After adjustment, HGS was predictive of 1-year and 30-day mortalities,
with odds ratios of 2.44 (95% confidence interval [CI] 1.39-4.29) and 2.83 (1.38-5.81),
respectively. HGS cutoffs of < 26 kg in men and < 16 kg in women had the highest predictive
performance.
Conclusions
HGS is a simple and effective tool to identify patients at higher risk of mortality
and protracted recovery after cardiac surgery.
Résumé
Contexte
Bien qu’il ait été démontré que les échelles de fragilité multidimensionnelles permettent
de prédire la mortalité et la morbidité associées à la chirurgie cardiaque, il est
nécessaire de disposer d’outils rapides qui pourraient être facilement utilisés au
lieu d’intervention. La force de préhension (FdP) est une option intéressante; elle
peut être mesurée chez les patients gravement malades et alités, même si elle doit
encore être confirmée avec une grande cohorte de patients en chirurgie cardiaque.
Méthodologie
Il s’agit d’une analyse a posteriori d’une étude pros-pective multicentrique chez
des patients âgés ayant subi un pontage aortocoronarien et/ou une chirurgie valvulaire
entre 2011 et 2019. La FdP a été mesurée avant la chirurgie et classée selon des seuils
stratifiés par sexe. Le paramètre d’évaluation principal était la mortalité à un an
et les paramètres d’évaluation secondaires étaient la mortalité à 30 jours, l’état
au moment du congé et la durée prolongée du séjour.
Résultats
L’analyse a porté sur 1 245 patients (âge moyen : 74,0 ± 6,6 ans; 30 % de femmes).
Une FdP peu élevée était associée à l’âge avancé, à l’insuffisance cardiaque, aux
maladies rénales, à la malnutrition et à diverses échelles de fragilité. Chez les
patients présentant une FdP peu élevée ou normale, respectivement, la mortalité à
un an était de 17 % vs 6 %, la mortalité à 30 jours, de 10 % vs 3 %, la durée prolongée
du séjour, de 34 % vs 19 % et l’admission dans un établissement de soins de santé
après le congé, de 45 % vs 26 % (tous les p < 0,001). Après ajustement, la FdP était un facteur prédictif de la mortalité à un
an et à 30 jours, avec un rapport de cotes de 2,44 (intervalle de confiance [IC] à
95 % : 1,39-4,29) et de 2,83 (IC à 95 % : 1,38-5,81), respectivement. Les seuils de
FdP de < 26 kg chez les hommes et de < 16 kg chez les femmes étaient ceux qui offraient
le meilleur pouvoir prédictif.
Conclusions
La FdP est un outil simple et efficace pour cibler les patients qui présentent un
risque plus élevé de mortalité et de récupération lente après une chirurgie cardiaque.
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Article Info
Publication History
Published online: August 28, 2021
Accepted:
August 9,
2021
Received:
May 15,
2021
Footnotes
See editorial by Heckman et al.,pages 1702–1704of this issue.
See page 1765 for disclosure information.
Identification
Copyright
© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
