The association of age, body mass index, and frailty with vestibular schwannoma surgical morbidity

Goshtasbi, Khodayar; Abouzari, Mehdi; Soltanzadeh-Zarandi, Sina; Sarna, Brooke; Lee, Ariel; Hsu, Frank P.K.; Djalilian, Hamid R.

doi:10.1016/j.clineuro.2020.106192

Cited by 8 publications

(25 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A single-center retrospective study conducted by Casazza et al found increasing frailty (by mFI score), and not age, independently associated with increasing hospital length of stay—a finding further bolstered by the present analysis. A recent study using the American College of Surgeons National Surgical Quality Improvement Program database arrived at the same finding using a mFI with 5 baseline factors but did not use multivariable analysis to evaluate the comparative influences of age and frailty on complications or clinical outcome. Taken collectively, the body of literature examining outcomes following VS resection demonstrates a significant prognostic value of frailty relative to increasing age alone with respect to clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

Associations of Baseline Frailty Status and Age With Outcomes in Patients Undergoing Vestibular Schwannoma Resection

Dicpinigaitis

Kalakoti

Schmidt

et al. 2021

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

IMPORTANCEAlthough numerous studies have evaluated the influence of advanced age on surgical outcomes following vestibular schwannoma (VS) resection, few if any large-scale investigations have assessed the comparative prognostic effects of age and frailty. As the population continues to age, it is imperative to further evaluate treatment and management strategies for older patients. OBJECTIVE To conduct a population-based evaluation of the independent associations of chronological age and frailty (physiological age) with outcomes following VS resection. DESIGN, SETTING, AND PARTICIPANTSIn this large-scale, multicenter, cross-sectional analysis, weighted discharge data from the National Inpatient Sample were searched to identify adult patients (Ն18 years old) who underwent VS resection from 2002 through 2017 using International Classification of Diseases, Ninth Revision, Clinical Modification and Tenth Revision, Clinical Modification codes. Data collection and analysis took place September to December 2020. MAIN OUTCOMES AND MEASURESComplex samples regression models and receiver operating characteristic curve analysis were used to evaluate the independent associations of frailty and age (along with demographic confounders) with complications and discharge disposition. Frailty was evaluated using the previously validated 11-point modified frailty index (mFI). RESULTS Among the 27 313 patients identified for VS resection, the mean (SEM) age was 50.4 (0.2) years, 15 031 (55.0%) were women, and 4720 (21.0%) were of non-White race/ethnicity, as determined by the National Inpatient Sample data source. Of the included patients, 15 090 (55.2%) were considered robust (mFI score = 0), 8204 (30.0%) were prefrail (mFI score = 1), 3022 (11.1%) were frail (mFI score = 2), and 996 (3.6%) were severely frail (mFI score Ն3). On univariable analysis, increasing frailty was associated with development of postoperative hemorrhagic or ischemic stroke (odds ratio [OR], 2.44 [95% CI, 2.07-2.87]; area under the curve, 0.73), while increasing age was not. Following multivariable analysis, increasing frailty and non-White race/ethnicity were independently associated with both mortality (adjusted OR [aOR], 2.32 [95% CI, 1.70-3.17], and aOR, 3.05 [95% CI, 1.02-9.12], respectively) and extended hospital stays (aOR, 1.54 [95% CI, and aOR, 1.71 [95% CI,.05], respectively), while increasing age was not. Increasing frailty (aOR, 0.61 [95% CI, 0.56-0.67]), age (aOR, 0.98 [95% CI, 0.97-0.99]), and non-White race/ethnicity (aOR, 0.62 [95% CI 0.51-0.75]) were all independently associated with routine discharge. CONCLUSIONS AND RELEVANCEIn this cross-sectional study, findings suggest that frailty may be more accurate for predicting outcomes and guiding treatment decisions than advanced patient age alone following VS resection.

show abstract

Section: Discussionmentioning

confidence: 99%

Associations of Baseline Frailty Status and Age With Outcomes in Patients Undergoing Vestibular Schwannoma Resection

Dicpinigaitis

Kalakoti

Schmidt

et al. 2021

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

show abstract

“…Furthermore, Researchers have discovered that older adults who report dizziness tend to be physically frail, have more chronic diseases and sensory impairments (de Moraes et al, 2011 , 2013 ; Gomez et al, 2011 ; Kammerlind et al, 2016 ). Dizziness, unsteadiness, or lightheadedness is associated with frailty, and in fully adjusted models, frailty was still related to dizziness, unsteadiness, or lightheadedness (O'Connell et al, 2015 ; Goshtasbi et al, 2020 ). Because of the limitations of observational epidemiological studies in eliminating bias (for example, reverse causation and confounding factors), while observational studies have reported a relationship between frailty and vestibular disease, little is known about their causal relationship.…”

Section: Discussionmentioning

confidence: 99%

Estimating the causal effect of frailty index on vestibular disorders: A two-sample Mendelian randomization

Xiao

Wang

et al. 2022

Front. Neurosci.

View full text Add to dashboard Cite

BackgroundFrailty index and vestibular disorders appear to be associated in observational studies, but causality of the association remains unclear.MethodsA two-sample Mendelian randomization (MR) study was implemented to explore the causal relationship between the frailty index and vestibular disorders in individuals of European descent. A genome-wide association study (GWAS) of frailty index was used as the exposure (n = 175, 226), whereas the GWAS of vestibular disorders was the outcome (n = 462,933). MR Steiger filtering method was conducted to investigate the causal effect of the frailty index on vestibular disorders. An inverse variance weighted (IVW) approach was used as the essential approach to examine the causality. Additionally, the MR-Egger methods, the simple mode analysis, the weighted median analysis, and the weighted mode analysis were used as supplementary methods. The MR-PRESSO analysis, the MR-Egger intercept analysis, and Cochran's Q statistical analysis also were used to detect the possible heterogeneity as well as directional pleiotropy. To evaluate this association, the odds ratio (OR) with 95% confidence intervals (CIs) was used. All statistical analyses were performed in R. The STROBE-MR checklist for the reporting of MR studies was used in this study.ResultsIn total, 14 single nucleotide polymorphisms (SNPs) were identified as effective instrumental variables (IVs) in the two sample MR analyses. The significant causal effect of the frailty index on vestibular disorders was demonstrated by IVW method [OR 1.008 (95% CI 1.003, 1.013), p = 0.001]. Results from the various sensitivity analysis were consistent. The “leave-one-out” analysis indicated that our results were robust even without a single SNP. According to the MR-Egger intercept test [intercept = −0.000151, SE = 0.011, p = 0.544], genetic pleiotropy did not affect the results. No heterogeneity was detected by Cochran's Q test. Results of MR Steiger directionality test indicated the accuracy of our estimate of the potential causal direction (Steiger p < 0.001).ConclusionThe MR study suggested that genetically predicted frailty index may be associated with an increased risk of vestibular disorders. Notably, considering the limitations of this study, the causal effects between frailty index and vestibular disorders need further investigation. These results support the importance of effectively managing frailty which may minimize vestibular disorders and improve the quality of life for those with vestibular disorders.

show abstract

“…Six studies included in this review evaluated the impact of obesity on postoperative LOS [19,20,22,24,26,28]. Only one study demonstrated that obesity was associated with a longer LOS using the ACS-NSQIP database [26].…”

Section: Length Of Hospital Staymentioning

confidence: 99%

Impact of Obesity on Postoperative Complications after Lateral Skull Base Surgery: A Systematic Review

Bridgham,

Shikara,

Ludeman

et al. 2023

ORL

View full text Add to dashboard Cite

Introduction: The relationship between obesity and complications after lateral skull base tumor resection is not clear. There is conflicting evidence regarding the incidence of postoperative complications in this patient population. The purpose of this study is to examine the relationship between obesity and outcomes following lateral skull base tumor resection. Data Sources: Data were extracted from PubMed, Embase, CINAHL, and Cochrane CENTRAL. Methods: Included studies assessed the relationship between obesity and outcomes following lateral skull base tumor removal. Studies with ≤5 patients, pediatric patients, duplicate patient populations, or insufficient data were excluded. Two independent investigators reviewed each study for inclusion. A third reviewer served as a tie-breaker for any conflicts. Extracted data includes patient demographics, tumor pathology, surgical approach, and postoperative outcomes including incidence of cerebrospinal fluid (CSF) leak and other postoperative complications, length of stay (LOS), and readmission and reoperation rates. Descriptive statistics were used to compare postoperative outcomes for obese and nonobese controls. Results: 14 studies met final inclusion criteria. Nine studies evaluated the relationship between obesity and CSF leaks. Four studies found a significant increase in postoperative CSF leak in obese patients compared to nonobese controls. The remaining studies trended toward an increased incidence of CSF leak in the obese population but did not reach statistical significance. One out of seven studies found that obesity increased postoperative LOS, and one out of five studies found that obesity increased reoperation rates following tumor resection. Conclusions: Based on the results, obesity does not appear to increase LOS, readmission, or reoperation rates after lateral skull base tumor resection. The relationship between obesity and postoperative CSF leak, however, warrants further analysis.

show abstract

The association of age, body mass index, and frailty with vestibular schwannoma surgical morbidity

Cited by 8 publications

References 45 publications

Associations of Baseline Frailty Status and Age With Outcomes in Patients Undergoing Vestibular Schwannoma Resection

Associations of Baseline Frailty Status and Age With Outcomes in Patients Undergoing Vestibular Schwannoma Resection

Estimating the causal effect of frailty index on vestibular disorders: A two-sample Mendelian randomization

Impact of Obesity on Postoperative Complications after Lateral Skull Base Surgery: A Systematic Review

Contact Info

Product

Resources

About