Preoperative sarcopenia and frailty are associated with poor outcomes in elderly patients undergoing cardiac surgery; this study aimed to investigate the effects of sarcopenia and frailty on postoperative recovery in elderly patients.

This prospective cohort study included 566 patients aged ≥60 years with an American Society of Anaesthesiologists (ASA) II–IV status who were scheduled for elective open-heart surgery between June 30, 2024, and April 5, 2026. Frailty was assessed using the Comprehensive Geriatric Assessment Frailty Index (CGA-FI). Sarcopenia was diagnosed based on the CT-based skeletal muscle index (SMI), grip strength, and physical function. The primary outcome was worsening disability or death within 3 months after surgery.A multivariate logistic regression model was used to estimate the association of sarcopenia and/or frailty with worsening disability or death within 3 months after surgery.

Patients with sarcopenia and frailty did not experience a reduction in disability burden within 3 months postoperatively [−2.0 (IQR: −9.0, 21.2)]. In contrast, patients with sarcopenia only and those with frailty only had significant reductions in the overall disability burden [−5.0 (IQR: −7.0, 0.0) and −5.0 (IQR: −8.0, −1.0)]. Compared with normal patients, those with both sarcopenia and frailty (OR = 3.09; 95% CI 1.61–5.96), those with sarcopenia only (OR = 2.65; 95% CI 1.38–5.12), and those with frailty only (OR 1.93; 95% CI 1.01–3.72) had a significantly increased risk of worsening disability or death within 3 months post-surgery.

Frailty, sarcopenia, and their combination are associated with a significantly increased risk of worsening disability or death within 3 months after surgery. Notably, compared with patients with both sarcopenia and frailty, those with frailty alone or sarcopenia alone have a lower burden of postoperative disability.