PhD Defense: Risk stratification and perioperative management of frail cardiovascular surgery patients

PhD Defense of Rosa Marie Smoor

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Estimating the surgical risk in older patients requiring major vascular or heart surgery is challenging because older patients have a higher risk of having additional serious illnesses and are more often frail. There is no consensus on the definition of frailty, but frail surgical patients have reduced physiological reserve, which makes them vulnerable to postoperative poor outcomes due to decreased tolerance of surgical stress. Being frail prior to surgery is also associated with poor quality of life after surgery, as well as with disability or dependent living. Recognizing frailty, however, can be difficult and time-consuming, since no standardized method exists.

This thesis evaluates new biomarkers of frailty with the goal of improving preoperative risk stratification for high-risk elderly patients. Additionally, this thesis evaluates perioperative treatment strategies and their association with postoperative outcomes in frail elderly individuals. Examples of measured biomarkers are advanced glycation end products (AGEs) in the skin,  cross-sectional abdominal muscle mass and density on CT-scan images, and hemoglobin (Hb) level.  Frailty prior to surgery is measured with a comprehensive frailty assessment.  Besides measuring the association of new biomarkers with frailty and poor outcome after surgery, this thesis also investigates decision-making strategies in patients who are very frail. Very high-risk patients are discussed in a multidisciplinary team (comprised of an anesthetist, surgeon, cardiologist, geriatrician, physical therapist, dietician, and pharmacist) prior to surgery. Members of the MDT consider factors such as operative risk, prehabilitation options, patients’ wishes, and alternative (less invasive) treatments. The optimal goal is to reduce the number of severe complications after surgery and maintain an acceptable quality of life and level of independence.

Start date and time
End date and time
Location
Academiegebouw, Domplein 29 & online (livestream link)
PhD candidate
R.M. Smoor
Dissertation
Risk stratification and perioperative management of frail cardiovascular surgery patients
PhD supervisor(s)
prof. dr. O.L. Cremer
Co-supervisor(s)
dr. P.G. Noordzij
dr. H.P.A. van Dongen