Novel risk factors for poor outcome in frail cardiac surgery patients

Arends, B.C. (2025)

Doctoral Thesis

Population aging and healthcare innovations have increased the number of elderly patients undergoing cardiac surgery, often resulting in a higher risk of chronic disease, frailty, and polypharmacy. This thesis evaluates novel risk factors for postoperative complications and poor functional outcomes in frail elderly patients using continuous monitoring data and pharmacokinetic models. Chapter 2 identifies polypharmacy as a predictor of postoperative functional decline, showing it improves preoperative risk classification. Chapter 3 reveals that chronic pain is common (35%) and linked to poor mobility, medication use, and preoperative quality of life, emphasizing the importance of frailty assessments for identifying high-risk patients. Chapters 4 and 5 focus on continuous monitoring after ICU discharge, showing that abnormal respiratory rates are associated with clinical deterioration and that opioids and benzodiazepines increase the risk of hypoxemia episodes, highlighting the need for careful monitoring of high-risk medications. Chapter 6 explores morphine pharmacokinetics and analgesic responses, revealing significant variability in pain management effectiveness among frail elderly patients, with oversedation common. This thesis underlines the importance of tailored perioperative care and further research into individualized pain management strategies to improve postoperative outcomes in frail elderly cardiac surgery patients. Recommendations for clinical care and future studies are provided.

• Frailty
• Polypharmacy
• Postoperative complications
• Cardiac surgery
• Chronic pain
• Functional decline
• Continuous monitoring
• High-risk medications
• Pharmacokinetics
• Elderly patients

• All authors: Arends, B.C.
• Supervisor: Biesma, D.H.
• Co-supervisor: Noordzij, P.G.; Blussé van Oud-Alblas, H.J.
• Committee: Achterberg, W.P.; Bouwman, R.A.; Buhre, W.F.F.A.; Klautz, R.J.M.; Sarton, E.Y.
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2025-05-09
• ISBN (print): 9789465068770
• Sponsorship: Financial support for the design and printing of this thesis was kindly provided by: Corporate Vitality, the Anesthesiology Research and Development department and Raad van Bestuur of the St. Antonius Hospital, Nieuwegein, de Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie (KNMP), and by Universitaire Bibliotheken Leiden (UBL), the Netherlands