Impact of Edmonton Frailty Score and Vitamin D Levels on Postoperative Outcomes of CABG in Older Adults

INTRODUCTION: To evaluate the impact of preoperative frailty, assessed by the Edmonton Frailty Score (EFS), and serum vitamin D and B12 levels on postoperative outcomes in elderly patients undergoing elective coronary artery bypass grafting (CABG).
METHODS: This retrospective cohort study included 62 patients aged ≥65 years who underwent elective CABG between June 2023 and December 2024. Demographic data, comorbidities, EFS, serum vitamin D (25-hydroxyvitamin D), and B12 levels were recorded. Postoperative outcomes included duration of mechanical ventilation, intensive care unit (ICU) stay, sternal dehiscence, wound infection, atrial fibrillation, pneumonia, and mortality. Associations among variables were analyzed using parametric and nonparametric tests and correspondence analysis.
RESULTS: The cohort consisted of 44 males (71%) with a mean age of 71.6±3.8 years. Vitamin D deficiency (<20ng/mL) was observed in 75% of males and 72% of females, while vitamin B12 deficiency (<200pg/mL) was identified in 18% of males and 22% of females. Lower vitamin D levels were significantly associated with prolonged mechanical ventilation and an increased risk of postoperative atrial fibrillation (p=0.013). No significant correlation was found for vitamin B12 levels. Higher EFS scores correlated positively with ICU stay, sternal dehiscence, wound infection, pneumonia, mortality, and longer mechanical ventilation times. Two in-hospital deaths occurred, both in patients with EFS ≥7 and vitamin D deficiency.
DISCUSSION AND CONCLUSION: Preoperative frailty and vitamin D deficiency are strong predictors of adverse postoperative outcomes in elderly patients undergoing CABG. Incorporating frailty and vitamin D assessment into preoperative evaluation may improve risk stratification and perioperative management, potentially reducing complications and improving outcomes.

Keywords: CABG, Edmonton score, frailty, vitamin D insufficiency.