Predictors of Health-Related Quality-of-Life after Cardiac Surgery: Findings from the ANesthesiology-QUality-Registry (ANQUR) and Frailty-Management

Background Assessment of long-term patient-reported outcome allows identification of vulnerable populations undergoing cardiac surgery. Incorporation of findings into clinical practice may enhance risk-stratification, prevent perioperative complications, and improve outcome. Frailty is prevalent in up to a third of cardiac patients and structured peri-procedural programs addressing frailty and delirium may be relevant to long-term outcome. This study aims to identify predictors of health-related quality-of-life one year after cardiac surgery and assess outcome in patients enrolled in an extensive frailty- and delirium-pathway. Methods Patients undergoing cardiac surgery at a high-volume German heart center were enrolled in an anesthesiology quality registry and health-related quality of life (HR-QoL) was assessed using the Short Form-12 (SF-12) questionnaire at 1-year-follow-up. Corresponding factors were analyzed for their association with individual outcome. The cohort comprised 812 patients. A subgroup of 190 patients participated in a frailty and delirium management program, providing extended preoperative screening and postoperative supervision. Results Female sex [B -2.56, 95% CI (-4.28 – -0.85)], increase in age [B -4.00, 95% CI (-6.17 – -1.83)] and weight [B -4.57, 95% CI (-6.53 – -2.60)], preoperative anemia [B -3.43, 95% CI (-5.77 – -1.10)], vascular comorbidities [B -3.37, 95% CI (-6.57 – -0.16)], smoking [B -2.73, 95% CI (-5.00 – -0.46)], increase in symptom burden [B -6.07, 95% CI (-11.55 – -0.59)] and physical frailty [B -9.90, 95% CI (-17.72 – -2.09)] were independently associated with lower physical outcome scores. Cognitive scores were higher in older patients [B 4.33, 95% CI (6.17–1.83)] and lower in smokers [B -2.18, 95% CI (-3.61 – -0.27)]. Conclusion Independent predictors of impaired HR-QoL at 1-year follow-up could be identified, suggesting a phenotype at risk. Physical frailty independently predicted poorer physical outcome, emphasizing potential for prehabilitation and frailty-management. Findings should be interpreted considering selection- and response-bias and absence of baseline HR-QoL-assessment. Trial registration This observational study complied with the Declaration of Helsinki and was approved by the Ethics Committee of the Medical Faculty of the Ruhr-University Bochum on 17th November 2022 (Registration-Number: 2022 − 947). Minor additions to the questionnaire were approved on 19th August 2024 (Registration-Number: 2022 − 947_1). Graphical abstract (Publication license available)