A Review of the Cost-Effectiveness of Frailty-Based Preoperative Assessment in Coronary Artery Bypass Grafting Patients

Background: Coronary artery bypass grafting (CABG) remains the gold standard for the management of
complex coronary artery disease despite advances in percutaneous coronary intervention. As the surgical
population becomes increasingly older and medically complex, frailty has emerged as an important
predictor ofpostoperative morbidity, mortality, prolonged hospitalization, and healthcare costs. Evaluating
the clinical and economic value of incorporating frailty assessment into routine preoperative care is
therefore of growing importance.
Objective: To review the current evidence on the role of frailty assessment in patients undergoing CABG,
with particular emphasis on its impact on clinical outcomes, risk stratification, and cost-effectiveness.
Methods: A comprehensive review of the published literature was conducted using peer-reviewed studies
addressing frailty assessment, CABG outcomes, and economic evaluation. Relevant evidence on
epidemiology, frailty assessment tools, perioperative outcomes, healthcare resource utilization, and costeffectiveness was synthesized to provide an integrated overview of current knowledge.
Results: Frailty was consistently associated with increased postoperative complications, prolonged
intensive care and hospital stays, higher readmission rates, impaired functional recovery, and increased
short- and long-term mortality following CABG. Validated frailty assessment instruments, including
phenotype- and deficit-based models and the Risk Analysis Index, improved preoperative risk stratification
beyond conventional surgical risk scores. Evidence also indicated that routine frailty screening facilitates
individualized perioperative management, targeted prehabilitation, and optimized resource allocation.
Economic evaluations suggest that incorporating frailty assessment into preoperative pathways is a costeffective strategy by reducing postoperative complications, shortening hospital stay, and improving qualityadjusted life years while lowering overall healthcare expenditure.