{"doi":"10.1111/jgs.18390","title":"Preoperative frailty and adverse outcomes following coronary artery bypass grafting surgery in <scp>US</scp> veterans","abstract":"BACKGROUND: Contemporary guidelines emphasize the value of incorporating frailty into clinical decision-making regarding revascularization strategies for coronary artery disease. Yet, there are limited data describing the association between frailty and longer-term mortality among coronary artery bypass grafting (CABG) patients. METHODS: We conducted a retrospective cohort study (2016-2020, 40 VA medical centers) of US veterans nationwide that underwent coronary artery bypass grafting (CABG). Frailty was quantified by the Veterans Administration Frailty Index (VA-FI), which applies the cumulative deficit method to render a proportion of 30 pertinent diagnosis codes. Patients were classified as non-frail (VA-FI ≤ 0.1), pre-frail (0.1 < VA-FI ≤ 0.2), or frail (VA-FI > 0.2). We used Cox proportional hazards models to ascertain the association of frailty with all-cause mortality. Our primary study outcome was 5-year all-cause mortality; the co-primary outcome was days alive and out of the hospital within the first postoperative year. RESULTS: There were 13,554 CABG patients (median 69 years, 79% White, 1.5% women). The mean pre-operative VA-FI was 0.21 (SD: 0.11); 31% were pre-frail (VA-FI: 0.17) and 47% were frail (VA-FI: 0.31). Frail patients were older and had higher co-morbidity burdens than pre-frail and non-frail patients. Compared with non-frail patients (13.0% [11.4, 14.7]), there was a significant association between frail and pre-frail patients and increased cumulative 5-year all-cause mortality (frail: 24.8% [23.3, 26.1]; HR: 1.75 [95% CI 1.54, 2.00]; pre-frail 16.8% [95% CI 15.3, 18.4]; HR 1.2 [1.08,1.34]). Compared with non-frail patients (mean 362[SD 12]), pre-frail (mean 361 [SD 14]; p < 0.01) and frail patients (mean 358[SD 18]; p < 0.01) spent fewer days alive and out of the hospital in the first postoperative year. CONCLUSIONS: Pre-frailty and frailty were prevalent among US veterans undergoing CABG and associated with worse mid-term outcomes. Given the high prevalence of frailty with attendant adverse outcomes, there may be an opportunity to improve outcomes by identifying and mitigating frailty before surgery.","journal":"Journal of the American Geriatrics Society","year":2023,"id":338315,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":17,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.833,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1070727,"name":"Salil V. Deo","orcid":"0000-0002-4729-1461","position":1,"is_corresponding":false},{"id":635486,"name":"Brian Charest","orcid":null,"position":2,"is_corresponding":false},{"id":1025169,"name":"Fanny Petermann‐Rocha","orcid":"0000-0002-4384-4962","position":3,"is_corresponding":false},{"id":1070728,"name":"Yakov Elgudin","orcid":"0000-0002-5249-1820","position":4,"is_corresponding":false},{"id":417787,"name":"Danny Chu","orcid":"0000-0002-2183-6072","position":5,"is_corresponding":false},{"id":74996,"name":"Robert W. Yeh","orcid":"0000-0002-0564-4468","position":6,"is_corresponding":false},{"id":302873,"name":"Sunil V. Rao","orcid":"0000-0003-2914-0894","position":7,"is_corresponding":false},{"id":270250,"name":"Dae Hyun Kim","orcid":"0000-0001-7290-6838","position":8,"is_corresponding":false},{"id":634333,"name":"Jane A. Driver","orcid":"0000-0001-9759-4607","position":9,"is_corresponding":false},{"id":320951,"name":"Daniel E. Hall","orcid":"0000-0001-6382-0522","position":10,"is_corresponding":false},{"id":341309,"name":"Ariela R. Orkaby","orcid":"0000-0002-4297-6306","position":11,"is_corresponding":false},{"id":376633,"name":"Ajar Kochar","orcid":"0000-0003-3570-2136","position":0,"is_corresponding":true}],"reference_count":38,"raw_metadata":null,"created_at":"2026-07-19T01:10:35.973121Z","pmid":"37083188","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}