Síndrome da fragilidade em cirurgia cardíaca: implicações funcionais e clínicas no perioperatório

Abstract

Introduction: Cardiovascular diseases are the leading cause of mortality in Brazil and worldwide, with a significant increase in the prevalence of conditions such as acute myocardial infarction and heart valve disease. In response, procedures such as coronary artery bypass grafting and valve replacement have become common, especially in the elderly, a group most vulnerable to frailty syndrome. This increases the risk of postoperative complications, such as pulmonary dysfunction and functional loss. Although guidelines for perioperative care exist, studies that comprehensively assess functionality, frailty, and lung function in this population are scarce. Objective: To assess frailty, functionality, lung function, and clinical outcomes in patients undergoing cardiac surgery. Method: Prospective cohort study, which followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines and evaluated 84 patients undergoing cardiac surgery at Hospital Cirurgia, in Aracaju, Sergipe state, in the preoperative period, third postoperative day, 30 and 90 days after discharge. The Fried frailty phenotype, the ICU Mobility Index (IMS) and Functional Independence Measure (FIM) scales, and spirometry were applied. Results: An increase in frailty from 19% preoperatively to 46% postoperatively (p = 0.003) was observed, associated with reduced muscle strength (p = 0.002), gait speed (p < 0.001) and spirometric parameters (FVC and FEV₁, p < 0.001). Functional mobility showed a significant decline on the third postoperative day (p = 0.004), and global functionality, measured by the FIM, also decreased significantly across the four time points evaluated (p < 0.001). Conclusion: The study identified increased frailty in the perioperative period of cardiac surgery, with a negative impact on mobility, lung function, and independence. Frailty was associated with functional worsening and slower recovery.