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Alare K, Muili A, Afolabi S, Adetunji B, Aderinto N, Abdulla E. The Prognostic Utility of Frailty on the Outcomes of Primary Brain Tumor Surgery Patients: A Meta-Analysis. World Neurosurg 2024:S1878-8750(24)01359-7. [PMID: 39127383 DOI: 10.1016/j.wneu.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/30/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Frailty refers to a state of weakness that can arise due to age or illnesses, and frailty predisposes individuals to several adverse health outcomes. This has been postulated to prognosticate the outcome of various surgeries, including surgeries for primary brain tumors; however, no meta-analysis has validated this finding. METHODS We conducted a systematic review and meta-analysis to investigate the prognostic utility of frailty for the outcome of primary brain tumor surgery. We performed a systematic search of the PubMed, EMBASE, and SCOPUS databases for studies investigating the ability of frailty to predict the outcome of primary brain tumor surgery. RESULTS Meta-analysis of the information provided in the thirteen studies that made up our sample. Hospital length of stay (effect size 0.94; 95% confidence interval [CI]: 0.37, 1.51; p: 0.00), postoperative complications (effect size 10.31; 95% CI: -5.88, 26.86; p: 0.21), readmission (effect size 0.82; 95% CI: 0.23, 1.41; p: 0.01), nonroutine discharge (effect size 1.07; 95% CI: 0.48, 1.65; 0.00), postoperative mortality (effect size 1.48; 95% CI: 0.81, 2.02; p: 0.00), and overall survival (effect size 1.53; 95% CI: 0.29, 2.76; p: 0.02). CONCLUSIONS This study showed little correlation with postoperative mortality, readmission, nonroutine discharge, length of hospital stay, or overall survival, and fragility had less significance in these areas but showed no statistical significance in predicting postoperative complications following surgery for primary brain tumors.
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Affiliation(s)
- Kehinde Alare
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, Texas, USA.
| | - Abdulbasit Muili
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Samson Afolabi
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Busayo Adetunji
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Nicholas Aderinto
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Ebtesam Abdulla
- Neurosurgery Department, Salmaniya Medical Complex, Manama, Bahrain
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Wong CE, Chang Y, Huang CC, Hsu HH, Lai YH, Chang KY, Huang CY, Wang LC, Lee JS, Lee PH. Surgical excision and radiotherapy for brain metastasis from colorectal cancer: How frailty and comorbidity indices influence outcome. Kaohsiung J Med Sci 2024; 40:395-403. [PMID: 38482966 DOI: 10.1002/kjm2.12815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/25/2023] [Accepted: 01/08/2024] [Indexed: 04/10/2024] Open
Abstract
The incidence of brain metastasis (BM) from colorectal cancer (CRC) is increasing. This study aims to identify the clinical prognosticators and evaluate the prognostic validity of common comorbidity indices in patients with BM from CRC. This retrospective single-center study analyzed 93 patients with BM from CRC who received surgical excision and/or radiotherapy. The clinical characteristics and prognostic indices including the 5-item modified frailty index (mFI-5) and prognostic nutritional index (PNI) were calculated from the collected patient data and analyzed. In this study, 66 (71.0%), 10 (10.8%), and 17 (18.3%) patients received whole-brain radiotherapy (WBRT) alone, surgery alone, and surgery plus WBRT, respectively. The median survival of all patients was 3.98 months (IQR: 1.74-7.99). The 2- and 3-year survival rates were 7.4% and 3.7%, respectively. Controlled primary tumor (p = 0.048), solitary BM (p = 0.001), surgery + radiation (p < 0.001), and greater PNI (p = 0.001) were independent predictors of favorable survival. In surgically treated patients, uncontrolled primary tumor (p = 0.006), presence of multiple BM (p < 0.001), and MFI-5 ≥ 2 (p = 0.038) were independent prognosticators. For patients who received WBRT, the presence of two (p = 0.004) or multiple (p < 0.001) BM and PNI (p < 0.001) were independent survival predictors MFI-5, multiple BM, and the status of the primary tumor were independent prognosticators for patients who underwent surgery for CRCBM. For patients who received WBRT, the PNI and the number of BM were independent survival predictors.
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Affiliation(s)
- Chia-En Wong
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu Chang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Chen Huang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hao-Hsiang Hsu
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Hsuan Lai
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kwang-Yu Chang
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Chih-Yuan Huang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Liang-Chao Wang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Shun Lee
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Hsuan Lee
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Gagliardi TA, Conti JT, Courville JT, Owodunni OP, Courville EN, Kazim SF, Schmidt MH, Bowers CA. The risk analysis index demonstrates exceptional discrimination in predicting frailty's impact on neurosurgical length of stay quality metrics. World J Surg 2024; 48:59-71. [PMID: 38686751 DOI: 10.1002/wjs.12020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/26/2023] [Indexed: 05/02/2024]
Abstract
BACKGROUND Quality measures determine reimbursement rates and penalties in value-based payment models. Frailty impacts these quality metrics across surgical specialties. We compared the discriminatory thresholds for the risk analysis index (RAI), modified frailty index-5 (mFI-5) and increasing patient age for the outcomes of extended length of stay (LOS [eLOS]), prolonged LOS within 30 days (pLOS), and protracted LOS (LOS > 30). METHODS Patients ≥18 years old who underwent neurosurgical procedures between 2012 and 2020 were queried from the ACS-NSQIP. We performed receiver operating characteristic analysis, and multivariable analyses to examine discriminatory thresholds and identify independent associations. RESULTS There were 411,605 patients included, with a median age of 59 years (IQR, 48-69), 52.2% male patients, and a white majority 75.2%. For eLOS: RAI C-statistic 0.653 (95% CI: 0.652-0.655), versus mFI-5 C-statistic 0.552 (95% CI: 0.550-0.554) and increasing patient age C-statistic 0.573 (95% CI: 0.571-0.575). Similar trends were observed for pLOS- RAI: 0.718, mFI-5: 0.568, increasing patient age: 0.559, and for LOS>30- RAI: 0.714, mFI-5: 0.548, and increasing patient age: 0.506. Patients with major complications had eLOS 10.1%, pLOS 26.5%, and LOS >30 45.5%. RAI showed a larger effect for all three outcomes, and major complications in multivariable analyses. CONCLUSION Increasing frailty was associated with three key quality metrics that is, eLOS, pLOS, LOS > 30 after neurosurgical procedures. The RAI demonstrated a higher discriminating threshold compared to both mFI-5 and increasing patient age. Preoperative frailty screening may improve quality metrics through risk mitigation strategies and better preoperative communication with patients and their families.
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Affiliation(s)
| | - Joseph T Conti
- New York Medical College School of Medicine, Valhalla, New York, USA
| | - Jordyn T Courville
- Louisiana State University Health and Sciences Center School of Medicine, Shreveport, Louisiana, USA
| | - Oluwafemi P Owodunni
- Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, New Mexico, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico, USA
| | - Evan N Courville
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico, USA
- Department of Neurosurgical Sciences, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Syed F Kazim
- Department of Neurosurgical Sciences, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Meic H Schmidt
- Department of Neurosurgical Sciences, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico, USA
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Forssten SP, Ahl Hulme R, Forssten MP, Ribeiro MAF, Sarani B, Mohseni S. Predictors of outcomes in geriatric patients with moderate traumatic brain injury after ground level falls. Front Med (Lausanne) 2023; 10:1290201. [PMID: 38152301 PMCID: PMC10751787 DOI: 10.3389/fmed.2023.1290201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/02/2023] [Indexed: 12/29/2023] Open
Abstract
Introduction The elderly population constitutes one of the fastest-growing demographic groups globally. Within this population, mild to moderate traumatic brain injuries (TBI) resulting from ground level falls (GLFs) are prevalent and pose significant challenges. Between 50 and 80% of TBIs in older individuals are due to GLFs. These incidents result in more severe outcomes and extended recovery periods for the elderly, even when controlling for injury severity. Given the increasing incidence of such injuries it becomes essential to identify the key factors that predict complications and in-hospital mortality. Therefore, the aim of this study was to pinpoint the top predictors of complications and in-hospital mortality in geriatric patients who have experienced a moderate TBI following a GLF. Methods Data were obtained from the American College of Surgeons' Trauma Quality Improvement Program database. A moderate TBI was defined as a head AIS ≤ 3 with a Glasgow Coma Scale (GCS) 9-13, and an AIS ≤ 2 in all other body regions. Potential predictors of complications and in-hospital mortality were included in a logistic regression model and ranked using the permutation importance method. Results A total of 7,489 patients with a moderate TBI were included in the final analyses. 6.5% suffered a complication and 6.2% died prior to discharge. The top five predictors of complications were the need for neurosurgical intervention, the Revised Cardiac Risk Index, coagulopathy, the spine abbreviated injury severity scale (AIS), and the injury severity score. The top five predictors of mortality were head AIS, age, GCS on admission, the need for neurosurgical intervention, and chronic obstructive pulmonary disease. Conclusion When predicting both complications and in-hospital mortality in geriatric patients who have suffered a moderate traumatic brain injury after a ground level fall, the most important factors to consider are the need for neurosurgical intervention, cardiac risk, and measures of injury severity. This may allow for better identification of at-risk patients, and at the same time resulting in a more equitable allocation of resources.
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Affiliation(s)
- Sebastian Peter Forssten
- Division of Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden
- Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden
| | - Rebecka Ahl Hulme
- Division of Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden
- Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Maximilian Peter Forssten
- Department of Orthopedic Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Marcelo A. F. Ribeiro
- Pontifical Catholic University of São Paulo, São Paulo, Brazil
- Khalifa University and Gulf Medical University, Abu Dhabi, United Arab Emirates
- Department of Surgery, Sheikh Shakhbout Medical City, Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Babak Sarani
- Division of Trauma and Acute Care Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Shahin Mohseni
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Surgery, Sheikh Shakhbout Medical City, Mayo Clinic, Abu Dhabi, United Arab Emirates
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Xavier F, Chouin E, Tighilet B, Lavieille JP, Chabbert C. Identification of Follow-Up Markers for Rehabilitation Management in Patients with Vestibular Schwannoma. J Clin Med 2023; 12:5947. [PMID: 37762888 PMCID: PMC10531600 DOI: 10.3390/jcm12185947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/30/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
This study delves into the absence of prognostic or predictive markers to guide rehabilitation in patients afflicted with vestibular schwannomas. The objective is to analyze the reweighting of subjective and instrumental indicators following surgery, at 7 days and 1 month postoperatively. This retrospective cohort encompasses 32 patients who underwent unilateral vestibular schwannoma surgery at the Marseille University Hospital between 2014 and 2019. Variations in 54 indicators and their adherence to available norms are calculated. After 1 month, one-third of patients do not regain the norm for all indicators. However, the rates of variation unveil specific responses linked to a preoperative error signal, stemming from years of tumor adaptation. This adaptation is reflected in a postoperative visual or proprioceptive preference for certain patients. Further studies are needed to clarify error signals according to lesion types. The approach based on variations in normative indicators appears relevant for post-surgical monitoring and physiotherapy.
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Affiliation(s)
- Frédéric Xavier
- Team Pathophysiology and Therapy of Vestibular Disorders, Laboratory of Cognitive Neurosciences, UMR7291, Aix Marseille University-CNRS, 13331 Marseille, France; (B.T.); (C.C.)
- Unit GDR2074, CNRS, Research Group on Vestibular Pathophysiology, 13331 Marseille, France;
| | - Emmanuelle Chouin
- Unit GDR2074, CNRS, Research Group on Vestibular Pathophysiology, 13331 Marseille, France;
| | - Brahim Tighilet
- Team Pathophysiology and Therapy of Vestibular Disorders, Laboratory of Cognitive Neurosciences, UMR7291, Aix Marseille University-CNRS, 13331 Marseille, France; (B.T.); (C.C.)
- Unit GDR2074, CNRS, Research Group on Vestibular Pathophysiology, 13331 Marseille, France;
| | - Jean-Pierre Lavieille
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital la Conception, Aix Marseille University, 13005 Marseille, France
| | - Christian Chabbert
- Team Pathophysiology and Therapy of Vestibular Disorders, Laboratory of Cognitive Neurosciences, UMR7291, Aix Marseille University-CNRS, 13331 Marseille, France; (B.T.); (C.C.)
- Unit GDR2074, CNRS, Research Group on Vestibular Pathophysiology, 13331 Marseille, France;
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6
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Qureshi HM, Tabor JK, Pickens K, Lei H, Vasandani S, Jalal MI, Vetsa S, Elsamadicy A, Marianayagam N, Theriault BC, Fulbright RK, Qin R, Yan J, Jin L, O'Brien J, Morales-Valero SF, Moliterno J. Frailty and postoperative outcomes in brain tumor patients: a systematic review subdivided by tumor etiology. J Neurooncol 2023; 164:299-308. [PMID: 37624530 PMCID: PMC10522517 DOI: 10.1007/s11060-023-04416-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/06/2023] [Indexed: 08/26/2023]
Abstract
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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Affiliation(s)
- Hanya M Qureshi
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Joanna K Tabor
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Kiley Pickens
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Haoyi Lei
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Sagar Vasandani
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Muhammad I Jalal
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Shaurey Vetsa
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Aladine Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Neelan Marianayagam
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Brianna C Theriault
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Robert K Fulbright
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
| | - Ruihan Qin
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
| | - Jiarui Yan
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
| | - Lan Jin
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Joseph O'Brien
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Saul F Morales-Valero
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA.
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA.
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Tarawneh OH, Vellek J, Kazim SF, Thommen R, Roster K, Conlon M, Alvarez-Crespo DJ, Cole KL, Varela S, Dominguez JF, Mckee RG, Schmidt MH, Bowers CA. The 5-item modified frailty index predicts spinal osteotomy outcomes better than age in adult spinal deformity patients: an ACS - NSQIP analysis. Spine Deform 2023; 11:1189-1197. [PMID: 37291408 DOI: 10.1007/s43390-023-00712-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/21/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE To evaluate the utility of 5-Item Modified Frailty Index (mFI-5) as compared to chronological age in predicting outcomes of spinal osteotomy in Adult Spinal Deformity (ASD) patients. METHODS Using Current Procedural and Terminology (CPT) codes, the American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP) database was queried for adult patients undergoing spinal osteotomy from 2015 to 2019. Multivariate regression analysis was performed to evaluate the effect of baseline frailty status, measured by mFI-5 score, and chronological age on postoperative outcomes. Receiver-operating characteristic (ROC) curve analysis was performed to analyze the discriminative performance of age versus mFI-5. RESULTS A total of 1,789 spinal osteotomy patients (median age 62 years) were included in the analysis. Among the patients assessed, 38.5% (n = 689) were pre-frail, 14.6% frail (n = 262), and 2.2% (n = 39) severely frail using the mFI-5. Based on the multivariate analysis, increasing frailty tier was associated with worsening outcomes, and higher odds ratios (OR) for poor outcomes were found for increasing frailty tiers as compared to age. Severe frailty was associated with the worst outcomes, e.g., unplanned readmission (OR 9.618, [95% CI 4.054-22.818], p < 0.001) and major complications (OR 5.172, [95% CI 2.271-11.783], p < 0.001). In the ROC curve analysis, mFI-5 score (AUC 0.838) demonstrated superior discriminative performance than age (AUC 0.601) for mortality. CONCLUSIONS The mFI5 frailty score was found to be a better predictor than age of worse postoperative outcomes in ASD patients. Incorporating frailty in preoperative risk stratification is recommended in ASD surgery.
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Affiliation(s)
- Omar H Tarawneh
- School of Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | - John Vellek
- School of Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, 87131, USA
| | - Rachel Thommen
- School of Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | - Katie Roster
- School of Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | - Matthew Conlon
- School of Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | | | - Kyril L Cole
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Samantha Varela
- School of Medicine, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Rohini G Mckee
- Department of Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Meic H Schmidt
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, 87131, USA
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, 87131, USA.
- Department of Neurosurgery MSC10 5615, Albuquerque, NM, 81731, USA.
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Nasrollahi TS, Shahrestani S, Borrelli M, Hopp ML, Wu AW, Tang DM, Yu JS. The Influence of Modifiable Risk Factors on Postoperative Outcomes in Patients Receiving Surgery for Resection for Acoustic Neuroma. EAR, NOSE & THROAT JOURNAL 2023:1455613231191020. [PMID: 37605484 DOI: 10.1177/01455613231191020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
Acoustic neuromas are the most common tumor of the cerebellopontine angle that are associated with a number of symptoms that negatively impact a patient's quality of life. While the mainstay of treatment for these benign tumors remains microsurgical resection, there is limited research exploring how certain modifiable risk factors (MRFs) may affect the perioperative course. The purpose of this study was to investigate how MRFs including malnutrition, obesity, dyslipidemia, uncontrolled hypertension, and smoking may affect postoperative rates of readmission and nonroutine discharges. We utilized the 2016 and 2017 Healthcare Cost and Utilization Project Nationwide Readmissions Database. MRFs were queried using appropriate International Classification of Diseases, Tenth Revision (ICD-10) coding for categories including malnutrition, obesity, dyslipidemia, smoking, alcohol, and hypertension. The statistical analysis was done using RStudio (Version 1.3.959). Chi-squared tests were done to evaluate differences between categorical variables. The Mann-Whitney U-testing was utilized to evaluate for statistically significant differences in continuous data. The "Epitools" package was used to develop logistic regression models for postoperative complications and post hoc receiver operating characteristic curves were developed. Pertaining to nonroutine discharge, predictive models using malnutrition outperformed all other MRFs as well as those with no MRFs (P < .05). In the case of readmission, models using malnutrition outperformed those of obesity and smoking (P < .05). Again, an increase in predictive power is seen in models using dyslipidemia when compared to obesity, smoking, or uncontrolled hypertension. Lastly, models using no MRFs outperformed those of obesity, smoking, and uncontrolled hypertension (P < .05). This is the first study of its kind to evaluate the role of MRFs in those undergoing surgical resection of their acoustic neuroma. We concluded that certain MRFs may play a role in complicating a patient's perioperative surgical course.
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Affiliation(s)
- Tasha S Nasrollahi
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Sinus Center of Excellence, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Shane Shahrestani
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michela Borrelli
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Sinus Center of Excellence, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Martin L Hopp
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Sinus Center of Excellence, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Arthur W Wu
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Sinus Center of Excellence, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dennis M Tang
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Sinus Center of Excellence, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John S Yu
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Budohoski KP, Rennert RC, Gordon SA, Raheja A, Brandon C, Henson JC, Azab MA, Patel NS, Karsy M, Gurgel RK, Shelton C, Couldwell WT. Factors associated with hearing outcomes after a middle fossa approach in 131 consecutive patients with vestibular schwannomas. J Neurosurg 2023; 139:432-441. [PMID: 36461828 DOI: 10.3171/2022.10.jns221525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/18/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The middle fossa approach is an effective option for the treatment of small (Koos grade I and II) vestibular schwannomas (VSs) when the goal is hearing preservation. The authors evaluated the rates of hearing preservation and examined the factors associated with improved hearing outcomes after the middle fossa approach for VSs. METHODS In this retrospective, single-center cohort study evaluating the clinical outcomes after resection of small VSs using the middle fossa approach, consecutive adult patients (> 18 years) who underwent surgery between January 2000 and December 2021 were included. Clinical and imaging characteristics were analyzed, including baseline hearing status, duration of surgery, anesthetic parameters, and imaging characteristics of the surgically treated tumors. RESULTS Among the 131 included patients, 102 had valid and discoverable pre- and postoperative audiology assessments. The mean follow-up was 26 months (range 1-180 months). There were 85 patients with serviceable hearing preoperatively, defined as American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A or B, of whom 78% retained class A or B hearing at the last follow-up. Binary logistic regression demonstrated that preoperative hearing AAO-HNS class (OR 0.19, 95% CI 0.05-0.77; p = 0.02), overlap between fundus and cochlea (OR 0.32, 95% CI 0.11-0.96; p = 0.04), and duration of anesthesia (OR 0.98, 95% CI 0.97-0.99; p = 0.03) were independent predictors of hearing outcomes. Additionally, 75% of patients with high diffusion-weighted imaging signal in the tumor (p = 0.009) and 67% of patients with the tumor originating at the modiolus of the cochlea (p = 0.004) had poor hearing outcomes. CONCLUSIONS The hearing preservation rates after microsurgical resection of small VSs using the middle fossa approach are high, with 78% of patients maintaining AAO-HNS class A or B hearing. Poor hearing status at baseline, longer duration of anesthesia, and large overlap between the fundus of the internal auditory canal and the cochlea were independently associated with unfavorable hearing outcomes. Imaging characteristics can be used to stratify patients' risk of hearing loss.
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Affiliation(s)
- Karol P Budohoski
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Robert C Rennert
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Steven A Gordon
- 2Division of Otolaryngology, University of Utah, Salt Lake City, Utah
| | - Amol Raheja
- 3Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Cameron Brandon
- 4College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - J Curran Henson
- 5University of Arkansas for Medical Sciences, Little Rock, Arkansas; and
| | - Mohammed A Azab
- 6Biomolecular Sciences Graduate Programs, Boise State University, Boise, Idaho
| | - Neil S Patel
- 2Division of Otolaryngology, University of Utah, Salt Lake City, Utah
| | - Michael Karsy
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Richard K Gurgel
- 2Division of Otolaryngology, University of Utah, Salt Lake City, Utah
| | - Clough Shelton
- 2Division of Otolaryngology, University of Utah, Salt Lake City, Utah
| | - William T Couldwell
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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Yuen E, Nguyen SA, Babb E, Wilkinson R, Meyer TA, McRackan TR. Impact of Patient Frailty on Speech Recognition and Quality of Life Outcomes in Adult Cochlear Implant Users. Otol Neurotol 2023:00129492-990000000-00321. [PMID: 37400136 DOI: 10.1097/mao.0000000000003933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVE The process of cochlear implantation (CI) and subsequent post-cochlear implant care is extensive and can be difficult to navigate for patients considered medically frail. This study investigates potential impact of patient frailty on speech recognition and quality of life outcomes after CI. STUDY DESIGN Retrospective review of a prospectively maintained database. SETTING Tertiary cochlear implant center. PATIENTS Three hundred seventy adults undergoing CI for traditional bilateral hearing loss indication. INTERVENTIONS None. MAIN OUTCOME MEASURES Comparison of pre-CI to 12-month post-CI change in consonant-nucleus-consonant phoneme/words, AzBio sentences in quiet/+10SNR, and Cochlear Implant Quality of Life (CIQOL)-35 Profile domain and global scores based on degree of patient frailty as assessed using the five-factor modified frailty index and Charlson Comorbidity Index. RESULTS The average age at implantation was 65.4 years (±SD, 15.7; 19-94 years). Overall, there were minimal to absent and nonsignificant differences in speech recognition outcomes (consonant-nucleus-consonant phoneme/words, and AzBio sentences +10SNR) based on pre-CI patient frailty. The exception was less improvement in AzBio quiet sentence score in patients noted to be severely frail based on Charlson Comorbidity Index (57.1% vs. 35.2%, d = 0.7 [0.3, 1]). Similar findings were observed for CIQOL-35 Profile domain and global scores where no associations were found other than decreased improvement in the social domain in patients noted to be severely frail (21.7 vs. -0.3, d = 1 [0.4, 1.7]). CONCLUSIONS Although some differences in outcomes were noted based on cochlear implant user frailty, these were small and isolated to only a few outcome measures. Therefore, assuming the patient is medically safe for surgery, preoperative frailty should not dissuade clinicians from recommending CI.
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Affiliation(s)
- Erick Yuen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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11
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Aghajanian S, Shafiee A, Ahmadi A, Elsamadicy AA. Assessment of the impact of frailty on adverse surgical outcomes in patients undergoing surgery for intracranial tumors using modified frailty index: A systematic review and meta-analysis. J Clin Neurosci 2023; 114:120-128. [PMID: 37390775 DOI: 10.1016/j.jocn.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Modified frailty index (MFI) is an emerging quantitative measure of frailty; however, the quantified risk of adverse outcomes in surgeries for intracranial tumors associated with increasing MFI scores has not been thoroughly reviewed in a comprehensive manner. METHODS MEDLINE (PubMed), Scopus, Web of Science, and Embase were searched to identify observational studies on the association between 5 and 11 item-modified frailty index (MFI) and perioperative outcomes for neurosurgical procedures including complications, mortality, readmission, and reoperation rate. Primary analysis pooled all comparisons with MFI scores greater than or equal to 1 versus non-frail participants using mixed-effects multilevel model for each outcome. RESULTS In total, 24 studies were included in the review and 19 studies with 114,707 surgical operations were included in the meta-analysis. While increasing MFI scores were associated with worse prognosis for all included outcomes, reoperation rate was only significantly higher in patients with MFI ≥ 3. Among surgical pathologies, glioblastoma was influenced by a greater extent to the impact of frailty on complications and mortality that most other etiologies. In agreement with qualitative evaluation of the included studies, meta-regression did not reveal association between mean age of the comparisons and complications rate. CONCLUSION The results of this meta-analysis provides quantitative risk assessment of adverse outcomes in neuro-oncological surgeries with increased frailty. The majority of literature suggests that MFI is a superior and independent predictor of adverse outcomes compared to age.
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Affiliation(s)
- Sepehr Aghajanian
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran; Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Arman Shafiee
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran; Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Ahmadi
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran; Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA.
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12
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Choi JS, Venteicher AS, Adams ME. Guiding Patients Through Decision-Making in Management of Sporadic Vestibular Schwannoma. Otolaryngol Clin North Am 2023; 56:459-469. [PMID: 37024332 DOI: 10.1016/j.otc.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Decision-making in management of sporadic vestibular schwannoma aims to identify the most appropriate options based on tumor characteristics, symptoms, health, and goals for each patient. Advances in knowledge of tumor natural history, improvements in radiation techniques, and achievements in neurologic preservation with microsurgery have shifted emphasis toward maximizing quality of life using a personalized approach. To empower patients to make informed decisions, we present a framework to help match patient values and priorities with reasonable expectations from modern management options. Introduced herein are practical examples of communication strategies and decision aids to support shared decision-making in modern practice.
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Affiliation(s)
- Janet S Choi
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, 420 Delaware Street Southeast, MMC 396, Minneapolis, MN 55455, USA
| | - Andrew S Venteicher
- Department of Neurosurgery, University of Minnesota, 420 Delaware Street Southeast, MMC 96, Minneapolis, MN 55455, USA; Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Meredith E Adams
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, 420 Delaware Street Southeast, MMC 396, Minneapolis, MN 55455, USA; Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
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13
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Jimenez AE, Mukherjee D. High-Value Care Outcomes of Meningiomas. Neurosurg Clin N Am 2023; 34:493-504. [DOI: 10.1016/j.nec.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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14
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Ng C, Dominguez JF, Hosein-Woodley R, Feldstein E, Naftchi A, Lui A, Dicpinigaitis AJ, McIntyre MK, Kaur G, Santarelli J, Bauerschmidt A, Mayer SA, Bowers CA, Gandhi CD, Al-Mufti F. Utility of frailty as a predictor of acute kidney injury in patients with aneurysmal subarachnoid hemorrhage. Interv Neuroradiol 2023; 29:114-120. [PMID: 35109710 PMCID: PMC9893237 DOI: 10.1177/15910199221076626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/31/2021] [Accepted: 01/11/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) is associated with poor outcome in aneurysmal subarachnoid hemorrhage patients (aSAH). Frailty has recently been demonstrated to correlate with elevated mortality and morbidity; its impact on predicting AKI and mortality in aSAH patients has not been investigated. OBJECTIVE Evaluating risk factors and predictors for AKI in aSAH patients. METHODS aSAH patients from a single-center's prospectively maintained database were retrospectively evaluated for development of AKI within 14 days of admission. Baseline demographic and clinical characteristics were collected. The effect of frailty and other risk factors were evaluated. RESULTS Of 213 aSAH patients, 53 (33.1%) were frail and 12 (5.6%) developed AKI. Admission serum creatinine (sCr) and peak sCr within 48 h were higher in frail patients. AKI patients showed a trend towards higher frailty. Mortality was significantly higher in AKI than non-AKI aSAH patients. Frailty was a poor predictor of AKI when controlling for Hunt and Hess (HH) grade or age. HH grade ≥ 4 strongly predicted AKI when controlling for frailty. CONCLUSION AKI in aSAH patients carries a poor prognosis. The HH grade appears to have superior utility as a predictor of AKI in aSAH patients than mFI.
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Affiliation(s)
- Christina Ng
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center and New York
Medical College, Valhalla, NY, USA
| | | | - Eric Feldstein
- Department of Neurosurgery, Westchester Medical Center and New York
Medical College, Valhalla, NY, USA
| | | | - Aiden Lui
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | | | - Matthew K McIntyre
- Department of Neurological Surgery, Oregon Health & Science
University, Portland, OR, USA
| | - Gurmeen Kaur
- Department of Neurosurgery, Westchester Medical Center and New York
Medical College, Valhalla, NY, USA
| | - Justin Santarelli
- Department of Neurosurgery, Westchester Medical Center and New York
Medical College, Valhalla, NY, USA
| | - Andrew Bauerschmidt
- Department of Neurosurgery, Westchester Medical Center and New York
Medical College, Valhalla, NY, USA
| | - Stephan A Mayer
- Department of Neurosurgery, Westchester Medical Center and New York
Medical College, Valhalla, NY, USA
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico School of
Medicine, Albuquerque, NM, USA
| | - Chirag D Gandhi
- Department of Neurosurgery, Westchester Medical Center and New York
Medical College, Valhalla, NY, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center and New York
Medical College, Valhalla, NY, USA
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15
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Cole KL, Babajanian E, Anderson R, Gordon S, Patel N, Dicpinigaitis AJ, Kazim SF, Bowers CA, Gurgel RK. Association of Baseline Frailty Status and Age With Postoperative Complications After Cochlear Implantation: A National Inpatient Sample Study. Otol Neurotol 2022; 43:1170-1175. [PMID: 36190901 DOI: 10.1097/mao.0000000000003717] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To conduct a national registry-based evaluation of the independent associations of chronological age and frailty, as measured by 5- and 11-factor modified frailty index (mFI-5, mFI-11) score, on postoperative outcomes of participants undergoing cochlear implantation (CI). STUDY DESIGN Cross-sectional analysis. SETTING Multicenter national database. PARTICIPANTS Adults 18 years or older who underwent CI during 2001 to 2018. MAIN OUTCOME MEASURES Any postoperative complications (determined as the presence of major, minor, or implant-specific), extended hospital length of stay (eLOS) (≥75th percentile of study population), and nonhome discharge destination. RESULTS There were 5,130 participants included with a median age of 60 years (interquartile range, 44-73 y) and slight female predominance (53.5%). Under mFI-5 scoring, there were 2,979 (58.1%) robust (mFI-5 = 0), 1710 (33.3%) prefrail (mFI-5 = 1), 362 (7.1%) frail (mFI-5 = 2), and 78 (1.5%) severely frail (mFI-5 ≥ 3) participants. Three hundred twenty-eight (6.49%) participants experienced a postoperative complication, with 320 (6.2%) discharged to a nonhome destination. Multivariate analysis showed no statistically significant correlation between increasing participant age or frailty status and postoperative complications; however, increasing baseline frailty tier showed an independent association with risk of eLOS (severely frail: odds ratio, 4..83; 95% confidence interval, 3.00-7.75; p < 0.001) and nonhome discharge (severely frail: odds ratio, 6.51; 95% confidence interval, 3.81-11.11; p < 0.001). The mFI-11 showed very similar trends. CONCLUSION Among those evaluated, this study demonstrates that CI is a low-risk procedure in participants of all ages. Increasing frailty does not predispose to postoperative complications. However, frail patients are at additional risk for an eLOS and nonhome discharge. Short follow-up time, hospital-coding errors, and selection bias of more robust patients may limit the true results of this study.
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Affiliation(s)
- Kyril L Cole
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Eric Babajanian
- Division of Otolaryngology, University of Utah, Salt Lake City, Utah, USA
| | - Ryan Anderson
- Division of Otolaryngology, University of Utah, Salt Lake City, Utah, USA
| | - Steve Gordon
- Division of Otolaryngology, University of Utah, Salt Lake City, Utah, USA
| | - Neil Patel
- Division of Otolaryngology, University of Utah, Salt Lake City, Utah, USA
| | | | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Richard K Gurgel
- Division of Otolaryngology, University of Utah, Salt Lake City, Utah, USA
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Gurgel RK, Couldwell WT, Patel NS, Cannon-Albright LA. Is There an Inherited Contribution to Risk for Sporadic Unilateral Vestibular Schwannoma? Evidence of Familial Clustering. Otol Neurotol 2022; 43:e1157-e1163. [PMID: 36113461 DOI: 10.1097/mao.0000000000003686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECT Unlike the autosomal dominant inheritance of neurofibromatosis 2, there are no known inherited risk factors for sporadic, unilateral vestibular schwannoma (VS), which comprise most VS cases. The authors tested a hypothesis positing a genetic contribution to predisposition to these lesions by analyzing familial clustering of cases. METHODS Familial clustering of individuals with unilateral VS was analyzed in two independent genealogical resources with linked diagnosis data: the Veterans Health Administration Genealogy Resource and the Utah Population Database. Tests for excess relatedness, estimation of relative risks (RRs) in close and distant relatives, and identification of pedigrees with a significant excess of unilateral VS among descendants were performed. RESULTS The average pairwise relatedness of the Veterans Health Administration Genealogy Resource VS cases significantly exceeded the expected relatedness ( p = 0.016), even when close relationships were ignored ( p = 0.002). RR for third- and fifth-degree relatives developing VS were significantly elevated (RR, 60.83; p = 0.0005; 95% confidence interval [CI], 7.37-219.73) and (RR, 11.88; p = 0.013; 95% CI, 1.44-42.90), respectively. No VS-affected first-, second-, or fourth-degree relatives were observed. In the Utah Population Database population, no first- or second-degree relatives with VS were observed. RR for fifth-degree relatives developing VS was significantly elevated (RR, 2.23; p = 0.009; 95% CI, 1.15-3.90). CONCLUSION These results provide strong evidence for an inherited predisposition to sporadic, unilateral VS. This study exhibits the value of genealogical resources with linked medical data for examining hypotheses regarding inherited predisposition. The high-risk unilateral VS pedigrees identified in two independent resources provide a powerful means of pursuing predisposition gene identification.
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Affiliation(s)
- Richard K Gurgel
- Division of Otolaryngology, University of Utah School of Medicine
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah
| | - Neil S Patel
- Division of Otolaryngology, University of Utah School of Medicine
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Dicpinigaitis AJ, Al-Mufti F, Bempong PO, Kazim SF, Cooper JB, Dominguez JF, Stein A, Kalakoti P, Hanft S, Pisapia J, Kinon M, Gandhi CD, Schmidt MH, Bowers CA. Prognostic Significance of Baseline Frailty Status in Traumatic Spinal Cord Injury. Neurosurgery 2022; 91:575-582. [PMID: 35944118 DOI: 10.1227/neu.0000000000002088] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/14/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Literature evaluating frailty in traumatic spinal cord injury (tSCI) is limited. OBJECTIVE To evaluate the prognostic significance of baseline frailty status in tSCI. METHODS Patients with tSCI were identified in the National Inpatient Sample from 2015 to 2018 and stratified according to frailty status, which was quantified using the 11-point modified frailty index (mFI). RESULTS Among 8825 operatively managed patients with tSCI identified (mean age 57.9 years, 27.6% female), 3125 (35.4%) were robust (mFI = 0), 2530 (28.7%) were prefrail (mFI = 1), 1670 (18.9%) were frail (mFI = 2), and 1500 (17.0%) were severely frail (mFI ≥ 3). One thousand four-hundred forty-five patients (16.4%) were routinely discharged (to home), and 320 (3.6%) died during hospitalization, while 2050 (23.3%) developed a severe complication, and 2175 (24.6%) experienced an extended length of stay. After multivariable analysis adjusting for age, illness severity, trauma burden, and other baseline covariates, frailty (by mFI-11) was independently associated with lower likelihood of routine discharge [adjusted odds ratio (aOR) 0.82, 95% CI 0.77-0.87; P < .001] and development of a severe complication (aOR 1.17, 95% CI 1.12-1.23; P < .001), but not with in-hospital mortality or extended length of stay. Subgroup analysis by age demonstrated robust associations of frailty with routine discharge in advanced age groups (aOR 0.71 in patients 60-80 years and aOR 0.69 in those older than 80 years), which was not present in younger age groups. CONCLUSION Frailty is an independent predictor of clinical outcomes after tSCI, especially among patients of advanced age. Our large-scale analysis contributes novel insights into limited existing literature on this topic.
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Affiliation(s)
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Phillip O Bempong
- School of Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jared B Cooper
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Alan Stein
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Piyush Kalakoti
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Simon Hanft
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Jared Pisapia
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Merritt Kinon
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Chirag D Gandhi
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Meic H Schmidt
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA
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Tang OY, Bajaj AI, Zhao K, Rivera Perla KM, Mary Ying YL, Jyung RW, Liu JK. In Reply: Association of Patient Frailty With Vestibular Schwannoma Resection Outcomes and Machine Learning Development of a Vestibular Schwannoma Risk Stratification Score. Neurosurgery 2022; 91:e141-e142. [DOI: 10.1227/neu.0000000000002155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/19/2022] Open
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Bowers CA, Varela S, Kazim SF, Gurgel R. Letter: Association of Patient Frailty With Vestibular Schwannoma Resection Outcomes and Machine Learning Development of a Vestibular Schwannoma Risk Stratification Score. Neurosurgery 2022; 91:e139-e140. [PMID: 36094282 DOI: 10.1227/neu.0000000000002154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/29/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Christian A Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, New Mexico, USA
| | - Samantha Varela
- School of Medicine, University of New Mexico (UNM), Albuquerque, New Mexico, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, New Mexico, USA
| | - Richard Gurgel
- Department of Otolaryngology, University of Utah, Salt Lake City, Utah, USA
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Cole KL, Varela S, Rumalla K, Kazim SF, Rebbe RW, Carvajal M, SantaCruz KS, McKee R, Willman C, Schmidt MH, Bowers CA. Advanced frailty assessment tool predicts successful awake craniotomy in a 92-year-old patient: A case report. Surg Neurol Int 2022; 13:404. [PMID: 36324951 PMCID: PMC9610602 DOI: 10.25259/sni_542_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background: The awake craniotomy (AC) procedure allows for safe and maximal resection of brain tumors from highly eloquent regions. However, geriatric patients are often viewed as poor candidates for AC due to age and medical comorbidities. Frailty assessments gauge physiological reserve for surgery and are valuable tools for preoperative decision-making. Here, we present a novel case illustrating how frailty scoring enabled an elderly but otherwise healthy female to undergo successful AC for tumor resection. Case Description: A 92-year-old right-handed female with history of hypertension and basal cell skin cancer presented with a 1-month history of progressive aphasia and was found to have a ring-enhancing left frontoparietal mass abutting the rolandic cortex concerning for malignant neoplasm. Frailty scoring with the recalibrated risk analysis index (RAI-C) tool revealed a score of 30 (of 81) indicating low surgical risk. The patient and family were counseled appropriately that, despite advanced chronological age, a low frailty score predicts favorable surgical outcomes. The patient underwent left-sided AC for resection of tumor and experienced immediate improvement of speech intraoperatively. After surgery, the patient was neurologically intact and had an unremarkable postoperative course with significant improvements from preoperatively baseline at follow-up. Conclusion: To the best of our knowledge, this case represents the oldest patient to undergo successful AC for brain tumor resection. Nonfrail patients over 90 years of age with the proper indications may tolerate cranial surgery. Frailty scoring is a powerful tool for preoperative risk assessment in the geriatric neurosurgery population.
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Xiao G, Wang H, Hu J, Liu L, Zhang T, Zhou M, Li X, Qin C. Estimating the causal effect of frailty index on vestibular disorders: A two-sample Mendelian randomization. Front Neurosci 2022; 16:990682. [PMID: 36090295 PMCID: PMC9448900 DOI: 10.3389/fnins.2022.990682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Frailty index and vestibular disorders appear to be associated in observational studies, but causality of the association remains unclear. Methods A 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. Results In 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). Conclusion The 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.
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Affiliation(s)
- Gui Xiao
- Department of Health Management, The Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Hu Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Jiaji Hu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Li Liu
- Department of Health Management, The Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Tingting Zhang
- Department of Health Management, The Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Mengjia Zhou
- Department of Health Management, The Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xingxing Li
- Department of Health Management, The Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Chunxiang Qin
- Department of Health Management, The Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
- *Correspondence: Chunxiang Qin
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22
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Tang OY, Bajaj AI, Zhao K, Liu JK. Patient frailty association with cerebral arteriovenous malformation microsurgical outcomes and development of custom risk stratification score: an analysis of 16,721 nationwide admissions. Neurosurg Focus 2022; 53:E14. [DOI: 10.3171/2022.4.focus2285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/18/2022] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Oliver Y. Tang
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ankush I. Bajaj
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kevin Zhao
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey
- Department of Neurological Surgery, New Jersey Medical School, Newark, New Jersey
- Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey
| | - James K. Liu
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey
- Department of Neurological Surgery, New Jersey Medical School, Newark, New Jersey
- Department of Otolaryngology–Head and Neck Surgery, New Jersey Medical School, Newark, New Jersey; and
- Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey
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23
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Vergara Olmos G, Dabiri S, Rutka J. Editorial. Decision-making in the surgical management of a vestibular schwannoma: when timing is everything (cum sincere omnia). J Neurosurg 2022; 136:1285-1286. [PMID: 34653982 DOI: 10.3171/2021.5.jns21981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Gabriela Vergara Olmos
- 1Division of Otology/Neurotology, Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Ontario, Canada
| | - Sasan Dabiri
- 1Division of Otology/Neurotology, Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Ontario, Canada
| | - John Rutka
- 1Division of Otology/Neurotology, Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Ontario, Canada
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24
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Barros G, Sen RD, McGrath M, Nistal D, Sekhar LN, Kim LJ, Levitt MR. Frailty predicts postoperative functional outcomes after microsurgical resection of ruptured brain arteriovenous malformations in older patients. World Neurosurg 2022; 164:e844-e851. [DOI: 10.1016/j.wneu.2022.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
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25
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Tang OY, Bajaj AI, Zhao K, Rivera Perla KM, Ying YLM, Jyung RW, Liu JK. Association of Patient Frailty With Vestibular Schwannoma Resection Outcomes and Machine Learning Development of a Vestibular Schwannoma Risk Stratification Score. Neurosurgery 2022; 91:312-321. [PMID: 35411872 DOI: 10.1227/neu.0000000000001998] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/12/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patient frailty is predictive of higher neurosurgical morbidity and mortality. However, existing frailty measures are hindered by lack of specificity to neurosurgery. OBJECTIVE To analyze the association between 3 risk stratification scores and outcomes for nationwide vestibular schwannoma (VS) resection admissions and develop a custom VS risk stratification score. METHODS We identified all VS resection admissions in the National Inpatient Sample (2002-2017). Three risk stratification scores were analyzed: modified Frailty Index-5, modified Frailty Index-11(mFI-11), and Charlson Comorbidity Index (CCI). Survey-weighted multivariate regression evaluated associations between frailty and inpatient outcomes, adjusting for patient demographics, hospital characteristics, and disease severity. Subsequently, we used k-fold cross validation and Akaike Information Criterion-based model selection to create a custom risk stratification score. RESULTS We analyzed 32 465 VS resection admissions. High frailty, as identified by the mFI-11 (odds ratio [OR] = 1.27, P = .021) and CCI (OR = 1.72, P < .001), predicted higher odds of perioperative complications. All 3 scores were also associated with lower routine discharge rates and elevated length of stay (LOS) and costs (all P < .05). Our custom VS-5 score (https://skullbaseresearch.shinyapps.io/vs-5_calculator/) featured 5 variables (age ≥60 years, hydrocephalus, preoperative cranial nerve palsies, diabetes mellitus, and hypertension) and was predictive of higher mortality (OR = 6.40, P = .001), decreased routine hospital discharge (OR = 0.28, P < .001), and elevated complications (OR = 1.59, P < .001), LOS (+48%, P < .001), and costs (+23%, P = .001). The VS-5 outperformed the modified Frailty Index-5, mFI-11, and CCI in predicting routine discharge (all P < .001), including in a pseudoprospective cohort (2018-2019) of 3885 admissions. CONCLUSION Patient frailty predicted poorer inpatient outcomes after VS surgery. Our custom VS-5 score outperformed earlier risk stratification scores.
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Affiliation(s)
- Oliver Y Tang
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ankush I Bajaj
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kevin Zhao
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, USA.,Department of Neurological Surgery, New Jersey Medical School, Newark, New Jersey, USA.,Saint Barnabas Medical Center, RWJBarnabas Health, Livingston, New Jersey, USA
| | - Krissia M Rivera Perla
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yu-Lan Mary Ying
- Saint Barnabas Medical Center, RWJBarnabas Health, Livingston, New Jersey, USA.,Department of Otolaryngology-Head and Neck Surgery, New Jersey Medical School, Newark, New Jersey, USA
| | - Robert W Jyung
- Saint Barnabas Medical Center, RWJBarnabas Health, Livingston, New Jersey, USA.,Department of Otolaryngology-Head and Neck Surgery, New Jersey Medical School, Newark, New Jersey, USA
| | - James K Liu
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, USA.,Department of Neurological Surgery, New Jersey Medical School, Newark, New Jersey, USA.,Saint Barnabas Medical Center, RWJBarnabas Health, Livingston, New Jersey, USA.,Department of Otolaryngology-Head and Neck Surgery, New Jersey Medical School, Newark, New Jersey, USA
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26
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Cole KL, Kazim SF, Thommen R, Alvarez-Crespo DJ, Vellek J, Conlon M, Tarawneh OH, Dicpinigaitis AJ, Dominguez J, McKee RG, Schmidt MH, Couldwell WT, Cole CD, Bowers CA. 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. Eur J Surg Oncol 2022; 48:1671-1677. [DOI: 10.1016/j.ejso.2022.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 12/13/2022] Open
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27
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Comparative associations of baseline frailty status and age with postoperative mortality and duration of hospital stay following metastatic brain tumor resection. Clin Exp Metastasis 2022; 39:303-310. [PMID: 35023030 DOI: 10.1007/s10585-021-10138-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/28/2021] [Indexed: 12/12/2022]
Abstract
Metastatic brain tumors are the most common intracranial neoplasms diagnosed in the United States. Although baseline frailty status has been validated as a robust predictor of morbidity and mortality across various surgical disciplines, evidence within cranial neurosurgical oncology is limited. Adult metastatic brain tumor patients treated with resection were identified in the National Inpatient Sample during the period of 2015-2018. Frailty was quantified using the 11-point modified frailty index (mFI-11) and its association with clinical endpoints was evaluated through complex samples multivariable logistic regression and receiver operating characteristic (ROC) curve analyses. Among 13,650 metastatic brain tumor patients identified (mean age 62.8 years), 26.8% (n = 3665) were robust (mFI = 0), 31.4% (n = 4660) were pre-frail (mFI = 1), 23.2% (n = 3165) were frail (mFI = 2), and 15.8% (n = 2160) were severely frail (mFI ≥ 3). On univariable assessment, these cohorts stratified by increasing frailty were significantly associated with postoperative complications (13.6%, 15.9%, 23.9%, 26.4%; p < 0.001), mortality (1.2%, 1.4%, 2.7%, 3.2%; p = 0.028), and extended length of stay (eLOS) (15.7%, 22.5%, 28.9%, 37.7%; p < 0.001). Following multivariable logistic regression analysis, frailty (by mFI-11) was independently associated with postoperative mortality (aOR 1.34, 95% CI 1.08, 1.65) and eLOS (aOR 1.26, 95% CI 1.17, 1.37), while increasing age was not associated with these endpoints. ROC curve analysis demonstrated superior discrimination of frailty (by mFI-11) in comparison with age for both mortality (AUC 0.61 vs. 0.58) and eLOS (AUC 0.61 vs. 0.53). Further statistical assessment through propensity score adjustment and decision tree analysis confirmed and extended the findings of the primary analytical models. Frailty may be a more robust predictor of postoperative outcomes in comparison with age following metastatic brain tumor resection.
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28
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Babajanian EE, Patel NS, Gurgel RK. The Impact of Cochlear Implantation: Cognitive Function, Quality of Life, and Frailty in Older Adults. Semin Hear 2021; 42:342-351. [PMID: 34912162 PMCID: PMC8660171 DOI: 10.1055/s-0041-1739367] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This review examines the relationship between cochlear implantation and cognition and quality of life in older adults, as well as how frailty affects outcomes for older patients with cochlear implants. A growing body of evidence suggests that there is a strong association between hearing loss and cognitive impairment. Preliminary studies suggest that cochlear implantation in older adults may be protective against cognitive decline. While studies have observed a positive impact of cochlear implantation on quality of life, currently it is unclear what factors contribute the most to improved quality of life. Frailty, as a measurement of general health, likely plays a role in complication rates and quality-of-life outcomes after cochlear implantation, though larger prospective studies are required to further elucidate this relationship.
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Affiliation(s)
- Eric E Babajanian
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Neil S Patel
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Richard K Gurgel
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
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29
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Dicpinigaitis AJ, Kazim SF, Schmidt MH, Couldwell WT, Theriault BC, Gandhi CD, Hanft S, Al-Mufti F, Bowers CA. Association of baseline frailty status and age with postoperative morbidity and mortality following intracranial meningioma resection. J Neurooncol 2021; 155:45-52. [PMID: 34495456 DOI: 10.1007/s11060-021-03841-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/04/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Although numerous studies have established advanced patient age as a risk factor for poor outcomes following intracranial meningioma resection, large-scale evaluation of frailty for preoperative risk assessment has yet to be examined. METHODS Weighted discharge data from the National Inpatient Sample were queried for adult patients undergoing benign intracranial meningioma resection from 2015 to 2018. Complex samples multivariable logistic regression models and receiver operating characteristic curve analysis were performed to evaluate adjusted associations and discrimination of frailty, quantified using the 11-factor modified frailty index (mFI), for clinical endpoints. RESULTS Among 20,250 patients identified (mean age 60.6 years), 35.4% (n = 7170) were robust (mFI = 0), 34.5% (n = 6985) pre-frail (mFI = 1), 20.1% (n = 4075) frail (mFI = 2), and 10.0% (n = 2020) severely frail (mFI ≥ 3). On univariable analysis, these sub-cohorts stratified by increasing frailty were significantly associated with the development of Clavien-Dindo grade IV (life-threatening) complications (inclusive of those resulting in mortality) (1.3% vs. 3.1% vs. 6.5% vs. 9.4%, p < 0.001) and extended length of stay (eLOS) (15.4% vs. 22.5% vs. 29.3% vs. 37.4%, p < 0.001). Following multivariable analysis, increasing frailty (aOR 1.40, 95% CI 1.17, 1.68, p < 0.001) and age (aOR 1.20, 95% CI 1.05, 1.38, p = 0.009) were both independently associated with development of life-threatening complications or mortality, whereas increasing frailty (aOR 1.20, 95% CI 1.10, 1.32, p < 0.001), but not age, was associated with eLOS. Frailty (by mFI-11) achieved superior discrimination in comparison to age for both endpoints (AUC 0.69 and 0.61, respectively). CONCLUSION Frailty may be more accurate than advanced patient age alone for prognostication of adverse events and outcomes following intracranial meningioma resection.
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Affiliation(s)
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Meic H Schmidt
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, 87106, USA
| | - William T Couldwell
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, 84132, USA
| | - Brianna Carusillo Theriault
- Department of Neurosurgery, Yale University School of Medicine/Yale New Haven Hospital, New Haven, CT, 06510, USA
| | - Chirag D Gandhi
- Department of Neurosurgery, Westchester Medical Center/New York Medical College, Valhalla, NY, 10595, USA
| | - Simon Hanft
- Department of Neurosurgery, Westchester Medical Center/New York Medical College, Valhalla, NY, 10595, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center/New York Medical College, Valhalla, NY, 10595, USA
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, 87106, USA. .,Department of Neurosurgery, University of New Mexico Health Sciences Center, MSC10 5615, 1 University of New Mexico, Albuquerque, NM, 81731, USA.
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