Abstract
<jats:p>Background. Risk stratification in elderly patients and the choice of surgical strategy are performed with consideration of frailty, which is an independent risk factor for adverse outcomes after non-cardiac surgery. Comprehensive preoperative preparation of frail patients is part of prehabilitation programs that are actively being implemented in modern medical practice. Goals of study was to analyze the level of frailty in patients with concomitant cardiovascular disease undergoing elective non-cardiac surgery; to assess the relationship between frailty and clinical characteristics, instrumental and laboratory findings, perioperative course, and in-hospital mortality; consequently, to evaluate the role of frailty in preoperative risk stratification to improve postoperative outcomes. Materials and methods. Frailty was assessed preoperatively in 150 patients who underwent elective non-cardiac surgery and had concomitant cardiovascular pathology. Functional capacity, physical status according to the ASA classification, clinical risk factors, echocardiographic findings, 12-lead ECG dynamics, general clinical and biochemical blood parameters, and NT-proBNP levels were analyzed. Frailty was evaluated using the Clinical Frailty Scale. Results. Frailty was identified in 28 % of patients, two-thirds of whom were male. Frail patients demonstrated lower functional capacity and had a higher burden of comorbidities (diabetes mellitus, anemia, cardiovascular diseases, higher creatinine and transaminase levels) as well as a higher Revised Cardiac Risk Index. Most of them (81 %) were classified as ASA III. Frail patients commonly exhibited signs of left ventricular dysfunction (reduced ejection fraction, increased Tei index, shortened aortic ejection time, impaired diastolic relaxation) and remodeling (changes in geometry). They also had significantly higher levels of natriuretic peptide, higher mean heart rate, and a tendency toward QT interval prolongation. Frail patients had longer hospital stays, and 43 % required postoperative intensive care (compared to 6.5 % of non-frail patients). More than one-third were rehospitalized during the follow-up period. Half of the frail patients died (compared to 3.7 % in the non-frail group), with 75 % of deaths occurring during hospitalization; the mean time to death was 23.67 ± 2.44 days. Conclusions. Frailty is associated with reduced functional capacity, higher comorbidity burden, increased anesthetic risk, greater need for intensive care, longer hospital stay, and higher mortality. The Clinical Frailty Scale is an accessible and reliable tool for patient stratification, aimed at optimizing postoperative recovery, improving surgical outcomes, and enhancing the quality of medical care.</jats:p>