Frail or fit for Surgery:
Dr. Greg Hirsch paves the way to better decisions and outcomes of cardiac surgery
Cardiac surgeon Dr. Greg Hirsch knows that age doesn't tell the story when it comes to deciding whether or not to go ahead with heart surgery. "A person's degree of frailty tells us a lot more about how they will respond to surgery and what kind of life they will have afterwards," says Dr. Hirsch, head of the Division of Cardiac Surgery at Dalhousie Medical School. "Our goal is to be able to better predict how each individual will fare with surgery, to empower them to make the decision that is right for them.”
As Dr. Hirsch explains, a fit person in their 80s could thrive for many high-quality years after a heart operation. On the other hand, a frail person in their 70s could suffer setbacks from the surgery that compromise their overall health and quality of life.
“Some surgery risks—such as infection or blood clots—apply to everyone, regardless of fitness or age,” explains Dr. Hirsch. “Then there are the risks that apply much more to those who are frail, which include time in intensive care and the possibility of contracting ventilator-associated pneumonia, delirium, and the need to be discharged to a nursing home instead of their own homes.”
Dr. Hirsch and his colleagues are launching a new research initiative to collect and analyze health and frailty information about cardiac patients, before and after surgery. This includes creating a ‘biobank’ to store blood and tissue samples, which they will examine for potential markers of frailty. “This data may lead the way to more precise ways to assess how well a person is likely to do after heart surgery,” he says. “If patients truly understand their health and the risks that surgery may pose, they can make decisions that reflect their own wishes and goals.”
This research also opens the door to new approaches to preparing people for surgery. “If we find a person is somewhat frail, we may be able to help them regain enough resilience before surgery that they will actually do well,” notes Dr. Hirsch. “We want to empower people to regain or maintain a quality of life that’s meaningful to them.”