Preoperative Frailty Score for 30-Day Morbidity and Mortality After Cranial Neurosurgery

Tomlinson, Samuel B.; Piper, Keaton; Kimmell, Kristopher T.; Vates, G. Edward

doi:10.1016/j.wneu.2017.07.081

Cited by 46 publications

(35 citation statements)

References 26 publications

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“…This is in contrast to the study herein showing the opposite finding for cSDH. This indicates that despite frailty being associated with poorer outcomes across all of neurosurgery [ 20 ], individual scoring systems must be validated for each disease type.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Frailty versus Initial Glasgow Coma Score in Predicting Outcomes Following Chronic Subdural Hemorrhage: A Preliminary Analysis

McIntyre

Rawanduzy

Afridi

et al. 2020

Cureus

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Background Initial Glasgow Coma Score (iGCS) is a well-known predictor of adverse outcomes following chronic subdural hemorrhage (cSDH). Frailty, i.e. a reduced physiologic reserve, is associated with poorer outcomes across the surgical literature, however, there is no consensus on the best measure of frailty. To date, no study has compared frailty’s ability to predict cSDH outcomes versus iGCS. The goal of this study was to, therefore, examine the prognostic value of the 5- (mFI-5) and 11-factor (mFI-11) modified frailty index, and Charlson Comorbidity Index (CCI) versus iGCS following cSDH. Methods Between January, 2016 and June, 2018, patients who presented to the emergency department with cSDH were retrospectively identified using the International Classification of Diseases (ICD) codes. mFI-5, mFI-11, and CCI scores were calculated using patient baseline characteristics. Primary endpoints were death and discharge home and subgroup analyses were performed among operative cSDH. Univariate and multivariate logistic regressions were used to determine predictors of primary endpoints. Results Of the 109 patients identified, the average age was 72.6±1.6 years and the majority (69/109, 63.3%) were male. The average CCI, mFI-5, and mFI-11 were 4.5 ±0.2, 1.5 ±0.1, and 2.2 ±0.1, respectively. Fifty (45.9%) patients required surgical intervention, 11 (10.1%) died, and 48 (43.4%) were discharged home. In the overall cohort, while the only multivariate predictor of mortality was iGCS (OR=0.58; 95%CI:0.44-0.77; p=0.0001), the CCI (OR=0.73; 95%CI:0.58-0.92; p=0.0082) was a superior predictor of discharge home compared to iGCS (OR=1.46; 95%CI:1.13-1.90; p=0.0041). Conversely, among those who received an operative intervention, the CCI, but not iGCS, independently predicted both mortality (OR=4.24; 95%CI:1.01-17.86; p=0.0491) and discharge home (OR=0.55; 95%CI:0.33-0.90; p=0.0170). Neither mFI nor age predicted primary outcomes in multivariate analysis. Conclusion While frailty is associated with worse surgical outcomes, the clinical utility of the mFI-5, mFI-11, and CCI in cSDH is unclear. We show that the iGCS is an overall superior predictor of mortality following cSDH but is outperformed by the CCI after operative intervention. Similarly, the CCI is the superior predictor of discharge home in cSDH patients overall and following an operative intervention. These results indicate that while the iGCS best predicts mortality overall, the CCI may be considered when prognosticating post-operative course and hospital disposition.

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Section: Discussionmentioning

confidence: 99%

The Effect of Frailty versus Initial Glasgow Coma Score in Predicting Outcomes Following Chronic Subdural Hemorrhage: A Preliminary Analysis

McIntyre

Rawanduzy

Afridi

et al. 2020

Cureus

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“…9 Several other studies have shown the mFI-5 to be a valid predictor of outcomes in patients undergoing various types of surgery. [10][11][12][13] However, to our knowledge, no study has validated the mFI-5 for use predicting outcomes in patients undergoing mastectomy. This could improve preoperative risk stratification, patient selection, and optimization prior to surgery, as has been seen in colorectal surgery.…”

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confidence: 99%

Predicting postoperative complications following mastectomy in the elderly: Evidence for the 5‐factor frailty index

et al. 2021

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Breast cancer remains the most commonly diagnosed cancer in women in the United States. 1 Surgical options include breast conservation surgery or mastectomy, with similar survival rates. 2,3 Patients who undergo mastectomy can subsequently decide to pursue immediate or delayed breast reconstruction. Postoperative complications of these procedures remain a major concern and lead to significant morbidity, including surgical site infection, skin flap necrosis, loss of implant, and need for reoperation. Complications can result in prolonged hospital stays, increased costs, and the delay of adjuvant therapy. 4 It is important to identify risk factors for post-mastectomy complications to provide adequate counseling and mitigate risk.Several predictors of surgical outcomes have been analyzed, including body mass index (BMI), smoking status, age, and medical comorbidities. More recently, the concept of frailty was introduced as a surrogate for physiologic age, with the goal of developing a more accurate predictor. Frailty is defined as a generalized, aging-related clinical state in which there is a diminished physiological reserve and function and an increased vulnerability to stressors, including surgery. 5 Frailty has been shown to be strongly associated with adverse outcomes, including postoperative complications, mortality,

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“…Pre- and postoperative modified Japanese Orthopedic Association (mJOA) were reviewed. [7] Patients were assigned Charlson comorbidity index (CCI) scores,[2] Elixhauser comorbidity index (ECI) scores,[3] and Edmonton frailty scale (EFS) scores[8] based on the review of electronic medical records. In addition, National Surgical Quality Improvement Program (NSQIP) scores were calculated to estimate surgical risks (American College of Surgeons NSQIP).…”

Section: Methodsmentioning

confidence: 99%

Minimally invasive cervical laminectomy for spondylotic myelopathy in medically fragile patients

Ross

O’Glasser

2019

Surgical Neurology International

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Background:Cervical spondylotic myelopathy often affects elderly and fragile patients who are not optimal candidates for major surgical procedures. Here, we report patients previously judged not suitable for cervical surgery, who were successfully treated with minimally invasive (MI) cervical decompressions without complications.Methods:Retrospectively, we reviewed medically fragile patients (e.g., too many comorbidities), previously deemed unsuitable for surgery who successfully tolerated MI cervical decompressions. The accompanying preoperative comorbidities, surgical risks, complications, and neurological outcomes were assessed.Results:Three male patients, with a mean age of 73 years, exhibited an average preoperative modified Japanese Orthopedic Association (mJOA) score of 8. The preoperative Charlson comorbidity indices, the Elixhauser comorbidity indices (respectively averaging 5.7 and 5.7 points, the preoperative Edmonton fragility index (average 12 points), and national surgical quality improvement program risks were calculated. Surgical times averaged 185 min and patients were followed for an average of 11.3 months. No patient had any immediate or delayed postoperative complications. The length of hospital stay was 1 day for each patient. The postoperative mJOA scores averaged 11, which was clinically significant. Further, the postoperative magnetic resonance imaging obtained approximately 3 months postoperative demonstrated adequate cord decompression.Conclusion:Medically fragile patients with significant cervical spondylotic myelopathy but major comorbidities precluding major surgery successfully underwent MI cervical decompressions.

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Preoperative Frailty Score for 30-Day Morbidity and Mortality After Cranial Neurosurgery

Cited by 46 publications

References 26 publications

The Effect of Frailty versus Initial Glasgow Coma Score in Predicting Outcomes Following Chronic Subdural Hemorrhage: A Preliminary Analysis

The Effect of Frailty versus Initial Glasgow Coma Score in Predicting Outcomes Following Chronic Subdural Hemorrhage: A Preliminary Analysis

Predicting postoperative complications following mastectomy in the elderly: Evidence for the 5‐factor frailty index

Minimally invasive cervical laminectomy for spondylotic myelopathy in medically fragile patients

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