Dr. Greg Hirsch
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 assessing someone's fitness for heart surgery. "A person's degree of frailty tells us a lot more than their age 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 better predict how each individual will fare, to empower them to make the decision that's 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 that compromise their 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, including delirium, time in intensive care, pneumonia, and the need to be discharged to a nursing home instead of their own homes.”
Dr. Hirsch and colleagues, including Dr. Ansar Hassan and Dr. Jean-François Légaré are gathering and analyzing health and frailty information about cardiac patients, before and up to six months after surgery. This includes collecting and storing blood and tissue samples to examine for potential markers of frailty. “We're creating more precise ways to predict how well a person is likely to do after heart surgery,” he says. “This predictive information, combined with the decision-making tools we're developing, will help patients better understand their health status and the risks that surgery may pose, so they can make decisions that reflect their wishes and goals.”
This research also opens the door to preparing frail people for surgery. “If we can identify specific markers of frailty in patients' blood samples, for example, it's possible we could modify those markers 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.”