Frailty as a Predictor of Postoperative Complications Following Skull Base Surgery

Henry, Roger; Reeves, Russell A.; Wackym, Phillip A.; Ahmed, Omar; Hanft, Simon; Kwong, Kelvin

doi:10.1002/lary.29485

Cited by 38 publications

(31 citation statements)

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“…We used the mFI-5 as a measure of frailty. Previously, mFI-5 has been documented as an effective predictor of postoperative morbidity and mortality in neurosurgical patients including those undergoing spine surgery [ 20 , 28 - 30 ]. The mFI-5 categorical assessment was reported to be essentially equivalent to the 11-factor modified frailty index (mFI-11) score for spine surgery patients [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

“…Previously, mFI-5 has been documented as an effective predictor of postoperative morbidity and mortality in neurosurgical patients including those undergoing spine surgery. [20,[28][29][30] The mFI-5 categorical assessment was reported to be essentially equivalent to the 11-factor modified frailty index (mFI-11) score for spine surgery patients. [20] The mFI-5 score was calculated for each patient based on the presence of DM, hypertension, CHF, COPD, and dependent functional status (Table 2).…”

Section: Modified Frailty Index-5 (Mfi-5)mentioning

confidence: 99%

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Frailty Status Is a More Robust Predictor Than Age of Spinal Tumor Surgery Outcomes: A NSQIP Analysis of 4,662 Patients

et al. 2022

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Objective: The present study aimed to evaluate the effect of baseline frailty status [as measured by modified frailty index-5 (mFI-5)] versus age on postoperative outcomes of patients undergoing surgery for spinal tumors using data from a large national registry. Methods:The National Surgical Quality Improvement Program (NSQIP) database was used to collect spinal tumor resection patients' data from 2015 to 2019 (n = 4662). Univariate and multivariate analyses for age and mFI-5 were performed for the following outcomes: 30-day mortality, major complications, unplanned reoperation, unplanned readmission, hospital length of stay (LOS), and discharge to a non-home destination. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative performance of age versus mFI-5. Results:Both univariate and multivariate analyses demonstrated that mFI-5 was a more robust predictor of worse postoperative outcomes as compared to age. Furthermore, based on categorical analysis of frailty tiers, increasing frailty was significantly associated with increased risk of adverse outcomes. 'Severely frail' patients were found to have the highest risk, with OR 16.4 (95% CI,11.21-35.44) for 30-day mortality, 3.02 (95% CI, 1.97-4.56) for major complications, and 2.94 (95% CI, 2.32-4.21) for LOS. In ROC curve analysis, mFI-5 score (AUC 0.743) achieved superior discrimination compared to age (AUC 0.594) for mortality. Conclusion:Increasing frailty, as measured by mFI-5, is a more robust predictor as compared to age, for poor postoperative outcomes in spinal tumor surgery patients. The mFI-5 may be clinically used for preoperative risk stratification of spinal tumor patients.

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Section: Methodsmentioning

confidence: 99%

Section: Modified Frailty Index-5 (Mfi-5)mentioning

confidence: 99%

Frailty Status Is a More Robust Predictor Than Age of Spinal Tumor Surgery Outcomes: A NSQIP Analysis of 4,662 Patients

et al. 2022

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“…[3][4][5] Recent studies have demonstrated the clinical value of frailty-diminishing physiological reserve associated with comorbidity burden-as a predictor of morbidity and mortality across various skull base procedures. [6][7][8] However, this frailty-outcome relationship is poorly characterized for patients undergoing cerebrovascular surgery. This gap in understanding is critical because patients with neurovascular pathologies often have significant comorbidity profiles leading to postoperative complications like intracranial hemorrhage and reoperation.…”

Section: Tang Et Almentioning

confidence: 99%

Patient frailty association with cerebral arteriovenous malformation microsurgical outcomes and development of custom risk stratification score: an analysis of 16,721 nationwide admissions

Tang

Bajaj

Zhao

et al. 2022

Neurosurgical Focus

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OBJECTIVE Patient frailty is associated with poorer perioperative outcomes for several neurosurgical procedures. However, comparative accuracy between different frailty metrics for cerebral arteriovenous malformation (AVM) outcomes is poorly understood and existing frailty metrics studied in the literature are constrained by poor specificity to neurosurgery. This aim of this paper was to compare the predictive ability of 3 frailty scores for AVM microsurgical admissions and generate a custom risk stratification score. METHODS All adult AVM microsurgical admissions in the National (Nationwide) Inpatient Sample (2002–2017) were identified. Three frailty measures were analyzed: 5-factor modified frailty index (mFI-5; range 0–5), 11-factor modified frailty index (mFI-11; range 0–11), and Charlson Comorbidity Index (CCI) (range 0–29). Receiver operating characteristic curves were used to compare accuracy between metrics. The analyzed endpoints included in-hospital mortality, routine discharge, complications, length of stay (LOS), and hospitalization costs. Survey-weighted multivariate regression assessed frailty-outcome associations, adjusting for 13 confounders, including patient demographics, hospital characteristics, rupture status, hydrocephalus, epilepsy, and treatment modality. Subsequently, k-fold cross-validation and Akaike information criterion–based model selection were used to generate a custom 5-variable risk stratification score called the AVM-5. This score was validated in the main study population and a pseudoprospective cohort (2018–2019). RESULTS The authors analyzed 16,271 total AVM microsurgical admissions nationwide, with 21.0% being ruptured. The mFI-5, mFI-11, and CCI were all predictive of lower rates of routine discharge disposition, increased perioperative complications, and longer LOS (all p < 0.001). Their AVM-5 risk stratification score was calculated from 5 variables: age, hydrocephalus, paralysis, diabetes, and hypertension. The AVM-5 was predictive of decreased rates of routine hospital discharge (OR 0.26, p < 0.001) and increased perioperative complications (OR 2.42, p < 0.001), postoperative LOS (+49%, p < 0.001), total LOS (+47%, p < 0.001), and hospitalization costs (+22%, p < 0.001). This score outperformed age, mFI-5, mFI-11, and CCI for both ruptured and unruptured AVMs (area under the curve [AUC] 0.78, all p < 0.001). In a pseudoprospective cohort of 2005 admissions from 2018 to 2019, the AVM-5 remained significantly associated with all outcomes except for mortality and exhibited higher accuracy than all 3 earlier scores (AUC 0.79, all p < 0.001). CONCLUSIONS Patient frailty is predictive of poorer disposition and elevated complications, LOS, and costs for AVM microsurgical admissions. The authors’ custom AVM-5 risk score outperformed age, mFI-5, mFI-11, and CCI while using threefold less variables than the CCI. This score may complement existing AVM grading scales for optimization of surgical candidates and identification of patients at risk of postoperative medical and surgical morbidity.

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“…We would like to thank Dr. Niño and colleagues for their letter highlighting considerations about the role of frailty in assessing perioperative risk in patients undergoing skull base surgery. 1 The authors identify other important factors that influence morbidity and mortality, including tumor biology, proximity to critical structures, and surgical approach among many others. We underscore that the modified 5-item frailty index (mFI-5) was not designed nor claimed to be an allencompassing risk stratifier.…”

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confidence: 99%

In Response to Other Factors That Alter Outcomes Following Skull Base Surgery

et al. 2021

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Frailty as a Predictor of Postoperative Complications Following Skull Base Surgery

Cited by 38 publications

References 30 publications

Frailty Status Is a More Robust Predictor Than Age of Spinal Tumor Surgery Outcomes: A NSQIP Analysis of 4,662 Patients

Frailty Status Is a More Robust Predictor Than Age of Spinal Tumor Surgery Outcomes: A NSQIP Analysis of 4,662 Patients

Patient frailty association with cerebral arteriovenous malformation microsurgical outcomes and development of custom risk stratification score: an analysis of 16,721 nationwide admissions

In Response to Other Factors That Alter Outcomes Following Skull Base Surgery

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