Association of baseline frailty status and age with outcomes in patients undergoing intracranial meningioma surgery: Results of a nationwide analysis of 5818 patients from the National Surgical Quality Improvement Program (NSQIP) 2015–2019

Cole, Kyril L.; Kazim, Syed Faraz; Thommen, Rachel; Alvarez-Crespo, Daniel J.; Vellek, John; Conlon, Matthew; Tarawneh, Omar; Dicpinigaitis, Alis J.; Dominguez, Jose F.; McKee, Rohini; Schmidt, Meic H.; Couldwell, William T.; Cole, Chad; Bowers, Christian A.

doi:10.1016/j.ejso.2022.02.015

Cited by 21 publications

(14 citation statements)

References 38 publications

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“…11,14 The mFI-5 has demonstrated superior discrimination in predicting postoperative outcomes compared with increasing patient age alone in a variety of neurosurgery, otolaryngology, orthopedic, urology, and plastic surgery publications. [15][16][17][18][19][20] More recently, the Risk Analysis Index-Administrative (RAI-A), a 14-question frailty score instrument, has been validated and may possess superior discriminatory ability compared with other frailty scales such as the mFI-5. [21][22][23] The RAI-A can readily be applied in under 1 minute in administrative research, at the patient's bedside or in clinic at the point of care, and follows a frailty conceptual framework.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Frailty Risk in Cranioplasty Patients: Risk Analysis Index Predicts Adverse Outcomes

Moya

Owodunni

Harrison

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Cranioplasty is a common surgical procedure used to repair cranial defects, and it is associated with significant morbidity and mortality. Although frailty is a strong predictor of poor postoperative outcomes across surgical specialties, little is known about frailty's impact on cranioplasty outcomes. This study examined the association between frailty and cranioplasty by comparing the effect of the Risk Analysis Index-Administrative (RAI-A) and the Modified Frailty Index-5 (mFI-5) on cranioplasty outcomes. Methods: The National Surgical Quality Improvement Program was queried for patients undergoing cranioplasty between 2012 and 2020. Receiver operating characteristics and multivariable analyses were used to assess the relationship of postoperative outcomes and the RAI-A, mFI-5, and increasing patient age. Results: There were 2864 included study patients with a median age of 57 years (IQR, 44-67), and a higher proportion of patients were women (57.0%) and White (68.5%). The RAI-A had a more robust predictive ability for 30-day mortality (C-Statistic, 0.741; 95% confidence interval (CI), 0.678-0.804) compared with mFI-5 (C-Statistic, 0.574; 95% CI, 0.489-0.659) and increasing patient age (C-Statistic, 0.671; 95% CI, 0.610-0.732). On multivariable analyses, frailty was independently associated with mortality and other poor postoperative outcomes (P < 0.05). Conclusions:The RAI-A demonstrated superior discrimination than the mFI-5 and increasing patient age in predicting mortality. Additionally, the RAI-A showed independent associations with nonhome discharge and postoperative complications (CDII, CDIIIb, and CDIV). The high rates of operative morbidity (5.0%-36.5%) and mortality (0.4%-3.2%) after cranioplasty highlight the importance of identifying independent risk factors for poor cranioplasty outcomes.

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Section: Introductionmentioning

confidence: 99%

Preoperative Frailty Risk in Cranioplasty Patients: Risk Analysis Index Predicts Adverse Outcomes

Moya

Owodunni

Harrison

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…This may obscure the true differences in hospital LOS, unplanned readmission rates, and in-hospital complications because frailty has been shown to be an independent predictor of these outcomes as well. 19,20…”

Section: Limitationsmentioning

confidence: 99%

Understanding the Unique Challenges Faced by Homeless Patients With Acute Traumatic Neurosurgical Injuries

et al. 2023

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BACKGROUND: Homelessness is associated with high risk of acute neurotraumatic injury in the ∼600 000 Americans affected on any given night. OBJECTIVE: To compare care patterns and outcomes between homeless and nonhomeless individuals with acute neurotraumatic injuries. METHODS: Adults hospitalized for acute neurotraumatic injuries between January 1, 2015, and December 31, 2020, were identified in this retrospective cross-sectional study at our Level 1 trauma center. We evaluated demographics, in-hospital characteristics, discharge dispositions, readmissions, and adjusted readmission risk. RESULTS: Of 1308 patients, 8.5% (n = 111) were homeless on admission to neurointensive care. Compared with nonhomeless individuals, homeless patients were younger (P = .004), predominantly male (P = .003), and less frail (P = .003) but had similar presenting Glasgow Coma Scale scores (P = .85), neurointensive care unit stay time (P = .15), neurosurgical interventions (P = .27), and in-hospital mortality (P = .17). Nevertheless, homeless patients had longer hospital stays (11.8 vs 10.0 days, P = .02), more unplanned readmissions (15.3% vs 4.8%, P < .001), and more complications while hospitalized (54.1% vs 35.8%, P = .01), particularly myocardial infarctions (9.0% vs 1.3%, P < .001). Homeless patients were mainly discharged to their previous living situation (46.8%). Readmissions were primarily for acute-on-chronic intracranial hematomas (4.5%). Homelessness was an independent predictor of 30-day unplanned readmissions (odds ratio 2.41 [95% CI 1.33-4.38, P = .004]). CONCLUSION: Homeless individuals experience longer hospital stays, more inpatient complications such as myocardial infarction, and more unplanned readmissions after discharge compared with their housed counterparts. These findings combined with limited discharge options in the homeless population indicate that better guidance is needed to improve the postoperative disposition and long-term care of this vulnerable patient population.

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“…There is a growing body of literature utilizing the modified frailty index 5 (mFI-5) to predict postoperative outcomes for patients undergoing various types of surgery using data collected for the American College of Surgeons prospective registry, the National Surgical Quality Improvement Program (NSQIP). [4][5][6] Age can be a useful predictor of postoperative outcomes but has shown to be worse than mFI-5 in some studies. 7 When mFI-5 has been studied specifically in microvascular reconstruction of the head and neck it has been shown to be a significant predictor of risk of longer hospitalization, reoperation, mortality, and unplanned readmission.…”

Section: Introductionmentioning

confidence: 99%

Frailty as a Predictor of Post-Surgical Outcomes in Patients With Cutaneous Malignancies of the Scalp and Neck Requiring Flap Reconstruction

Welch

Kazim

Esce

et al. 2023

Ann Otol Rhinol Laryngol

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Background: Investigate the ability of frailty status to predict post-surgical outcomes in patients with cutaneous malignancies of the scalp and neck undergoing flap reconstruction. Methods: National Surgical Quality Improvement Program database was used to isolate patients with cutaneous malignancies of the scalp and neck who underwent surgical resection between 2015 to 2019. Univariate and multivariate analyses were performed to determine if frailty score correlated with negative post-operative outcomes. Receiver operating characteristic (ROC) curves allowed testing of the discriminative performance of age versus frailty. Results: This study demonstrated an independent correlation between frailty and major complications as well as non-home discharge. In ROC curve analysis, frailty demonstrated superior discrimination compared to age for predicting major complications. Conclusion: Our study demonstrated an association between increasing frailty and major complications as well as the likelihood of a non-home discharge. When compared to age, frailty was also shown to be a better predictor of major complications.

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Association of baseline frailty status and age with outcomes in patients undergoing intracranial meningioma surgery: Results of a nationwide analysis of 5818 patients from the National Surgical Quality Improvement Program (NSQIP) 2015–2019

Cited by 21 publications

References 38 publications

Preoperative Frailty Risk in Cranioplasty Patients: Risk Analysis Index Predicts Adverse Outcomes

Preoperative Frailty Risk in Cranioplasty Patients: Risk Analysis Index Predicts Adverse Outcomes

Understanding the Unique Challenges Faced by Homeless Patients With Acute Traumatic Neurosurgical Injuries

Frailty as a Predictor of Post-Surgical Outcomes in Patients With Cutaneous Malignancies of the Scalp and Neck Requiring Flap Reconstruction

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