Analysis of readmissions data among frail and non-frail patients presenting for acoustic neuroma

Nasrollahi, Tasha; Shahrestani, Shane; Borrelli, Michela; Raskin, Jonathan; Hopp, Martin L.; Wu, Arthur W.; Miller, M. David; Wong, Yu‐Tung

doi:10.1016/j.jocn.2022.03.013

Cited by 8 publications

(6 citation statements)

References 29 publications

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“…The concept of frailty has gained much traction in recent years as studies have identified its use to be more predictive of postoperative outcomes, compared to age alone. The analysis found that the frail group had statistically significant higher rates of readmission, postoperative infection, facial paralysis, urinary tract infection, and hydrocephalus [ 75 ]. If elderly patients are more prone to develop general complications after surgery (including acute cardiac events, stroke, bleeding, postoperative delirium, prolonged inpatient stays as well as mortality), complications specific to VS and its removal, including cerebrospinal fluid leak or FN dysfunction, were not shown to be significantly higher, as shown on a population of 452 patients divided by age cutoff > 70 years [ 76 , 77 ].…”

Section: Resultsmentioning

confidence: 99%

Factors Influencing Personalized Management of Vestibular Schwannoma: A Systematic Review

Sergi

Settimi

Federici

et al. 2022

JPM

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Management of vestibular schwannoma (VS) is a complex process aimed at identifying a clinical indication for fractionated stereotactic radiotherapy (sRT) or microsurgical resection or wait and scan (WS). The aim of the review was to clarify which patient and tumor parameters may lead to different therapeutic choices, with a view to a personalized VS approach. A systematic review according to Preferred Reporting Items for Systematic Review and Meta-Analysis criteria was conducted between February and March 2022. The authors defined six parameters that seemed to influence decision-making in VS management: 1-incidental VS; 2-tumor size; 3-tumor regrowth after sRT; 4-subtotal resection; 5-patients’ age; 6-symptoms. The initial search yielded 3532 articles, and finally, 812 articles were included. Through a qualitative synthesis of the included studies, management strategies were evaluated and discussed. An individualized proposal of procedures is preferable as compared to a single gold-standard approach in VS decision-making. The most significant factors that need to be considered when dealing with a VS diagnosis are age, tumor size and hearing preservation issues.

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Section: Resultsmentioning

confidence: 99%

Factors Influencing Personalized Management of Vestibular Schwannoma: A Systematic Review

Sergi

Settimi

Federici

et al. 2022

JPM

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“…Other studies examining the effect of craniotomy for brain tumor resection, Chiari malformation repair, and acoustic neuroma resection all demonstrated increased rates of complication or nonhome discharge in the patients with increased frailty. [16][17][18] There are several possible explanations including the fact that endoscopic approach does not require any external incisions and involves lower insensible losses when compared to open procedures. Furthermore it utilized the natural sinonasal corridor for access to the skull base and typically does not require retraction of intracranial structures.…”

Section: Discussionmentioning

confidence: 99%

“…In our study we did not record anesthesia time, but lumbar drain use did not appear to be related to complications. Other studies examining the effect of craniotomy for brain tumor resection, Chiari malformation repair, and acoustic neuroma resection all demonstrated increased rates of complication or nonhome discharge in the patients with increased frailty 16–18 …”

Section: Discussionmentioning

confidence: 99%

Endoscopic Repair of Anterior Skull Base Cerebrospinal Fluid Leaks is Successful in Frail Patients

Eide,

Kshirsagar,

Wen

et al. 2024

The Laryngoscope

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ObjectiveSurgical frailty estimates a patient's ability to withstand the physiologic stress of an intervention. There is limited data regarding the impact of frailty on endoscopic cerebrospinal fluid (CSF) leak repair.MethodsPatients undergoing CSF leak repair at two tertiary academic skull base programs were retrospectively reviewed. Demographic, treatment, and postoperative outcomes data were recorded. Frailty was calculated using validated indices, including the American Society of Anesthesiologists (ASA) classification, Charlson Comorbidity Index (CCI), and the Modified 5‐Item Frailty Index (mFI‐5). Outcomes included 30‐day medical and surgical complications and readmission.ResultsA total of 185 patients were included with 128 (69.2%) female patients and average age of 54 ± 14 years. The average body mass index was 34.6 ± 8.5. The most common identified etiology was idiopathic intracranial hypertension (IIH) in 64 patients (34.6%). A total of 125 patients (68%) underwent perioperative lumbar drain placement (primarily to measure intracranial pressures and diagnose IIH). Most patients were ASA class 3 (48.6%) with mean CCI 2.14 ± 2.23 and mFI‐5 0.97 ± 0.90. Three patients had postoperative CSF leaks, with an overall repair success rate of 98.4%. There was no association between increased frailty and 30‐day medical outcomes, surgical outcomes, or readmission (all p > 0.05).ConclusionsEndoscopic CSF leak repair in a frail population, including lumbar drain placement and bed rest, was not associated with an increased rate of complications. Previous data suggests increased complications in open craniotomy procedures in patients with significant comorbidities. This study suggests that the endoscopic approach to CSF leak repair is well tolerated in the frail population.Level of EvidenceIV Laryngoscope, 2024

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“…Though limited, several studies have explored frailty’s relationship with postoperative outcomes in patients with vestibular schwannoma. Like studies in patients with meningioma and GBM, Nasrollahi et al report that frail geriatric patients with vestibular schwannoma are more likely to experience increased readmission rates, LOS, and non-home discharges [ 47 ]. The authors also report on higher postoperative infection, facial paralysis, urinary tract infection, hydrocephalus, and dysphagia rates specifically in geriatric patients with vestibular schwannoma [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

“…Like studies in patients with meningioma and GBM, Nasrollahi et al report that frail geriatric patients with vestibular schwannoma are more likely to experience increased readmission rates, LOS, and non-home discharges [ 47 ]. The authors also report on higher postoperative infection, facial paralysis, urinary tract infection, hydrocephalus, and dysphagia rates specifically in geriatric patients with vestibular schwannoma [ 47 ]. While Helal et al suggest frail, elderly patients can safely undergo surgery for vestibular schwannoma, their small cohort was a limiting factor [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Frailty and postoperative outcomes in brain tumor patients: a systematic review subdivided by tumor etiology

Qureshi,

Tabor,

Pickens

et al. 2023

J Neurooncol

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Purpose Frailty has gained prominence in neurosurgical oncology, with more studies exploring its relationship to postoperative outcomes in brain tumor patients. As this body of literature continues to grow, concisely reviewing recent developments in the field is necessary. Here we provide a systematic review of frailty in brain tumor patients subdivided by tumor type, incorporating both modern frailty indices and traditional Karnofsky Performance Status (KPS) metrics. Methods Systematic literature review was performed using PRISMA guidelines. PubMed and Google Scholar were queried for articles related to frailty, KPS, and brain tumor outcomes. Only articles describing novel associations between frailty or KPS and primary intracranial tumors were included. Results After exclusion criteria, systematic review yielded 52 publications. Amongst malignant lesions, 16 studies focused on glioblastoma. Amongst benign tumors, 13 focused on meningiomas, and 6 focused on vestibular schwannomas. Seventeen studies grouped all brain tumor patients together. Seven studies incorporated both frailty indices and KPS into their analyses. Studies correlated frailty with various postoperative outcomes, including complications and mortality. Conclusion Our review identified several patterns of overall postsurgical outcomes reporting for patients with brain tumors and frailty. To date, reviews of frailty in patients with brain tumors have been largely limited to certain frailty indices, analyzing all patients together regardless of lesion etiology. Although this technique is beneficial in providing a general overview of frailty’s use for brain tumor patients, given each tumor pathology has its own unique etiology, this combined approach potentially neglects key nuances governing frailty’s use and prognostic value.

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Analysis of readmissions data among frail and non-frail patients presenting for acoustic neuroma

Cited by 8 publications

References 29 publications

Factors Influencing Personalized Management of Vestibular Schwannoma: A Systematic Review

Factors Influencing Personalized Management of Vestibular Schwannoma: A Systematic Review

Endoscopic Repair of Anterior Skull Base Cerebrospinal Fluid Leaks is Successful in Frail Patients

Frailty and postoperative outcomes in brain tumor patients: a systematic review subdivided by tumor etiology

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