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Background
Frailty complicates management and worsens outcomes. We assessed the prevalence, determinants and consequences of frailty among elderly patients in a hospital setting.
Design
Retrospective observational study in a Swiss university hospital.
Methods
22,323 patients aged ≥65 years hospitalized between January 2009 and December 2017 at the internal medicine ward were included. Frailty was defined by the Hospital Frailty Risk Score (HFRS) and patients were categorized as low (HFRS<5), intermediate (HFRS 5–15) and high (HFRS>15) risk.
Results
Overall prevalence of intermediate and high risk of frailty was 43% and 20%, respectively; prevalence was higher in women and increased with age. Prevalence of high risk of frailty increased from 11.4% in 2009 to 31% in 2012, and decreased to 19.2% in 2017. After multivariable adjustment, frailty was associated with increased length of stay: average and (95% confidence interval) 11.9 (11.7–12.1), 15.6 (15.4–15.8) and 19.7 (19.3–20.1) days for low, intermediate and high risk, respectively, and increased likelihood of ICU stay: odds ratio (OR) and (95% CI) 1.57 (1.41–1.75) and 2.10 (1.82–2.42) for intermediate and high risk, respectively, p for trend <0.001. Frailty was associated with increased likelihood of hospital costs >70,000 CHF: OR and (95% CI) 3.46 (2.79–4.29) and 10.7 (8.47–13.6) for intermediate and high risk, respectively, p for trend <0.001, and with a lower likelihood of complete cost coverage: OR and (95% CI) 0.70 (0.65–0.76) and 0.52 (0.47–0.58) for intermediate and high risk, respectively, p for trend<0.001.
Conclusions
Frailty is a frequent condition among hospitalized patients and is associated with higher costs.
Background Postoperative intracranial hypotension-associated venous congestion (PIHV) is a rare event. The authors report the case of a patient presenting with PIHV after spinal surgery following the sudden loss of cerebrospinal fluid (CSF) induced by suction drainage.
Methods A 69-year-old patient underwent uneventful revision surgery for wound dehiscence after lumbar surgery with placement of a subfascial suction drain.
Results Postoperatively, the patient presented with fluctuating consciousness and a generalized tonic–clonic seizure. Computed tomography (CT) and serial magnetic resonance imaging (MRI) were performed showing convexity subarachnoid hemorrhages (SAHs), diffuse swelling of the brain and thalami and striatum bilaterally without diffusion restriction, and signs of intracranial hypertension resulting in pseudohypoxic brain swelling in PIHV. A dural leak at L3–L4 was treated with several CT-guided patches combining autologous blood and fibrin glue injections. The patient recovered without neurologic deficit and follow-up MRI revealed progressive complete reversal of brain swelling, and re-expansion of CSF spaces.
Conclusion PIHV is a rare but potentially fatal entity. Awareness of PIHV after cranial or spinal surgery leads to early treatment of CSF hypovolemia and possibly better clinical outcome. Following acute CSF volume loss, an acute elevation of cerebral blood volume overcoming autoregulatory mechanisms seems a likely explanation for diffuse cerebral vasogenic edema and SAH in PIHV.
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