Supporting data for “Unravelling the dynamic patterns of frailty trajectory and factors shaping its changes in patients undergoing coronary artery and/or valve surgery”

Frailty is a clinical syndrome characterized by a loss of physiological reserves across multiple organ systems and compromised resilience to stressors. It has emerged as an important prognostic indicator in patients undergoing cardiac surgery, associated with increased mortality, a higher risk of postoperative complications, prolonged hospital stays, and hospital readmissions. Therefore, recognizing and addressing frailty is essential to improving surgical outcomes. Despite robust evidence on the prognostic significance of frailty, limited research has examined frailty trajectories in cardiac surgical patients and the factors shaping their changes over time. Indeed, frailty is a dynamic condition influenced by a multitude of factors. Understanding frailty trajectories is crucial for identifying high-risk populations and determining the optimal timing for interventions. This knowledge informs perioperative care planning and early interventions, thereby reducing the risk of adverse outcomes and preventing further frailty deterioration. Identifying predictors of frailty trajectories also enables the development of individualized interventions targeting modifiable risk factors, ultimately enhancing patient resilience and recovery.This study adopted a mixed methods design, comprising a prospective cohort study aimed to investigate the trajectories of frailty in patients undergoing coronary artery and/or valve surgery and the potential factors influencing frailty changes, and a qualitative study to explore the postoperative recovery experience of patients, focusing on their perceptions of frailty and how they understand, interpret, and adapt to changes and challenges after surgery. A total of 305 adult patients undergoing elective cardiac surgery, including coronary artery bypass grafting (CABG), valve replacement or repair surgeries, and combined CABG and valve surgeries, were recruited from three regional hospitals in Hong Kong. Frailty was measured preoperatively (one day to one week before the scheduled operation), and postoperatively at one, three, and six months. Group-based trajectory modeling identified four distinct groups of frailty trajectory: robust maintained, prefrail improved, prefrail worsened, and frail maintained. Multinomial logistic regression revealed predictors of each trajectory. Higher physical activity level, being overweight, and participation in cardiac rehabilitation after surgery significantly predicted higher odds of frailty improvement. Conversely, higher comorbidity burden, being underweight, kinesiophobia, a threatening illness perception, longer cardiopulmonary bypass duration, postoperative complications, longer hospital stays, and unplanned hospital readmissions were associated with frailty progression or maintaining a frail state. Higher levels of education and cardiac self-efficacy were protective factors against frailty worsening. A subset of 30 patients participated in qualitative interviews at three and six months post-surgery. Thematic analysis identified five themes: the nonlinear recovery journey, fear-driven behavioral adjustments, frailty through a personal lens, deficiencies in postoperative rehabilitation pathways, and psychosocial impacts of surgery. These themes revealed how patients’ perceptions of frailty, along with the physical, emotional, psychosocial, and systemic challenges they encountered, influenced postoperative outcomes.This study is the first to examine frailty trajectories in cardiac surgical patients and the factors influencing them. Findings highlight the dynamic nature of frailty and help informing risk stratification and perioperative care planning. Routine frailty assessments and comprehensive screening for frailty risk factors are recommended to enable early identification and management, ultimately improving patient outcomes.衰弱（frailty）是一种临床综合征，以多器官系统生理储备丧失、对应激源的抵抗能力受损为特征。现已成为心脏手术患者的重要预后指标，与更高的死亡率、术后并发症风险、更长的住院时长及更高的再住院率相关。因此，识别并干预衰弱对改善手术结局至关重要。尽管已有充分证据证实衰弱的预后价值，但针对心脏手术患者衰弱轨迹及其随时间变化影响因素的研究尚且不足。实际上，衰弱是一种受多重因素影响的动态状态。明确衰弱轨迹，对于识别高危人群、确定最优干预时机均具有关键价值。此类认知可为围术期护理规划与早期干预提供科学依据，进而降低不良结局风险，延缓衰弱进展。识别衰弱轨迹的预测因素，还有助于制定针对可干预危险因素的个体化干预方案，最终提升患者的抵抗能力与康复效果。 本研究采用混合研究设计，包含两部分：一是前瞻性队列研究，旨在探讨冠状动脉和/或瓣膜手术患者的衰弱轨迹及其影响因素；二是定性研究，以探索患者的术后康复体验，重点关注其对衰弱的认知，以及对术后变化与挑战的理解、诠释与适应过程。研究从香港三家区域医院招募了305名接受择期心脏手术的成年患者，手术类型包括冠状动脉旁路移植术（CABG）、瓣膜置换或修补术，以及CABG联合瓣膜手术。分别于术前（预定手术前1天至1周）、术后1、3及6个月测量患者的衰弱状态。通过基于群体的轨迹建模，识别出4种不同的衰弱轨迹类型：持续强健、衰弱前期改善、衰弱前期恶化、持续衰弱。多项逻辑回归分析揭示了各轨迹类型的预测因素：较高的身体活动水平、超重状态及术后参与心脏康复，均显著预测了衰弱改善的更高概率。反之，更高的共病负荷、体重过轻、恐动症（kinesiophobia）、威胁性疾病感知、更长的体外循环时长、术后并发症、更长的住院时长与非计划再住院，均与衰弱进展或维持衰弱状态相关；较高的受教育水平与心脏自我效能感（cardiac self-efficacy），则是阻止衰弱恶化的保护因素。另有30名患者在术后3、6个月参与了定性访谈，主题分析法识别出5个主题：非线性康复历程、恐惧驱动的行为调整、基于个人视角的衰弱认知、术后康复路径的不足，以及手术带来的社会心理影响。这些主题揭示了患者对衰弱的认知，及其遭遇的生理、情绪、社会心理与系统性挑战，如何影响术后结局。 本研究是首个针对心脏手术患者衰弱轨迹及其影响因素的研究。研究结果凸显了衰弱的动态特性，可为风险分层与围术期护理规划提供参考。研究建议常规开展衰弱评估，并对衰弱危险因素进行全面筛查，以实现早期识别与干预，最终改善患者的临床结局。