A comparison of frailty indices in predicting length of inpatient stay and discharge destination following angiogram-negative subarachnoid hemorrhage

The Association of Modified 5-Item Frailty Index on Perioperative Cochlear Implant Speech Perception

OBJECTIVE

This study aims to evaluate the potential association of perioperative hearing outcomes with frailty by Modified 5-Item Frailty Index (mFI-5).

DESIGN

Retrospective cross-sectional study.

SETTING

Single-institutional study conducted at a tertiary care hospital between January 2018 and January 2022.

PATIENTS

All adult patients older than 50 years who underwent cochlear implantation (CI).

INTERVENTIONS

Cochlear implantation.

MAIN OUTCOMES MEASURES

Hearing outcomes were measured using pre-CI and longitudinal post-CI quiet AzBio scores. Frailty was determined by mFI-5 scores (0 = not frail, 1 = prefrail, and 2+ = frail). Univariable and multivariable linear regressions, ordinal logistic regressions, and time-to-event curves were used to determine perioperative speech perception and likelihood of high-performance hearing (defined as ≥70% on AzBio).

RESULTS

Of the 126 patients, the median age was 70 (63-77) years, 50% (63) were female, and 39% (49) identified as non-Hispanic Black, Hispanic, or other. By mFI-5 scoring, 38% (48) had no frailty, with 34% (43) and 28% (35) scoring 1 and 2+, respectively. When adjusting for age, sex, race, and BMI, scoring 1 point on mFI-5 was associated with significantly lower pre-implantation and post-implantation AzBio scores (pre: = -15 [-26, -3.4], p < 0.05; post: = -14 [-25, -3.0], p < 0.05). When controlling for all covariates, prefrailty and frailty were associated with significantly decreased likelihood of high-performance hearing (prefrailty OR: 0.22 [0.07, 0.63], p < 0.01; frailty OR: 0.31 [0.10, 0.92], p < 0.05). Time-to-event curves demonstrate significantly reduced likelihood of reaching high-performance hearing within 7 months after CI in patients with mFI-5 scores >0 (p < 0.05).

CONCLUSION AND RELEVANCE

Our findings suggest that prefrailty is associated with worse pre-CI and post-CI hearing and lower likelihood of high-performance hearing within 7 months post-CI. Preoperative frailty screening in adult CI candidates may better inform providers of patients' long-term risk-to-benefit.

Development and Validation of Machine Learning-Based Model for Hospital Length of Stay in Patients Undergoing Endovascular Interventional Embolization for Intracranial Aneurysms

OBJECTIVE

This study was to explore the factors associated with prolonged hospital length of stay (LOS) in patients with intracranial aneurysms (IAs) undergoing endovascular interventional embolization and construct prediction model machine learning algorithms.

METHODS

Employing a retrospective cohort study design, this study collected patients with ruptured IA who received endovascular treatment at Jingzhou First People's Hospital during the inclusion period from September 2022 to December 2023. The entire dataset was randomly split into training and testing dataset with a 7:3 ratio. Six machine learning models including logistic regression support vector machine, random forest (RF), extreme gradient boosting, K-nearest neighbors, and Naive Bayes were constructed. Each model was assessed using sensitivity with a 95% confidence interval (CI), specificity, positive predictive value, negative predictive value, area under the curve (AUC), accuracy, and F1-score. The performance of the optimal model was compared against other models using the net reclassification index and the integrated discrimination improvement.

RESULTS

In this study, 325 patients were enrolled, with 227 assigned to the training set and 98 to the testing set. The training set comprised 163 patients with LOS below the third quartile and 64 patients with LOS at or above the third quartile. Age, Hunt-Hess grade, National Institutes of Health and Stroke Scale, white blood cell count, Fisher grade above II, moderate aneurysm size, preoperative dexmedetomidine administration, and postoperative complications including electrolyte imbalance correction, encephaledema, and respiratory system disease were identified as predictive factors. The RF model exhibited the best predictive performance with an AUC of 0.928 (95% CI: 0.895-0.961) in the training set. This high performance was consistent in the testing set, where the AUC remained strong at 0.912 (95% CI: 0.851-0.973).

CONCLUSIONS

This study comprehensively identified key predictive factors for prolonged LOS in patients with IA undergoing interventional embolization and confirmed the efficacy of an RF model for predicting prolonged LOS in patients with IA undergoing interventional embolization. The construction of the LOS prediction model may effectively optimize healthcare resource utilization, inform better clinical decision-making, and offer valuable prognostic insights.

Impact of Frailty Risk on Functional Outcome after Aneurysmal Subarachnoid Hemorrhage: A Historical Cohort Study

We evaluated the utility of the Hospital Frailty Risk Score (HFRS) as a predictor of adverse events post-hospitalization in a retrospective analysis of patients undergoing neurosurgical procedures due to aneurysmal subarachnoid hemorrhage (SAH). This historical cohort study analyzed the data of patients hospitalized with aneurysmal SAH (n = 1,343) between April 2014 and August 2020 who were registered in the JMDC database. We used HFRS to classify the patients into the low-frailty risk group (HFRS < 5) and high-frailty risk group (HFRS ≥ 5). The primary outcome was a modified Rankin Scale (mRS) score of 0-2 points at discharge. Of 1,343 patients, 1,001 (74.5%) and 342 (25.5%) were in the low- and high-frailty risk groups, respectively. A high-frailty risk was negatively associated with a mRS score of 0-2 at discharge (high-frailty risk group: odds ratio 0.4; 95% confidence interval [CI]: 0.3-0.6) and home discharge (high-frailty risk group: odds ratio 0.5; 95% CI: 0.4-0.7). A high-frailty risk was negatively associated with Barthel Index gain (high-frailty risk group: coefficient -10.4, 95% CI: -14.7 to -6.2) and had a longer length of stay (high-frailty risk group: coefficient 8.4, 95% CI: 5.1-11.7). HFRS could predict adverse outcomes during hospitalization of aneurysmal SAH patients.

Predictive Ability of Comorbidity Indices for Surgical Morbidity and Mortality: a Systematic Review and Meta-analysis

BACKGROUND

Several contemporary risk stratification tools are now being used since the development of the Charlson Comorbidity Index (CCI) in 1987. The purpose of this systematic review and meta-analysis was to compare the utility of commonly used co-morbidity indices in predicting surgical outcomes.

METHODS

A comprehensive review was performed to identify studies reporting an association between a pre-operative co-morbidity measurement and an outcome (30-day/in-hospital morbidity/mortality, 90-day morbidity/mortality, and severe complications). Meta-analysis was performed on the pooled data.

RESULTS

A total of 111 included studies were included with a total cohort size 25,011,834 patients. The studies reporting the 5-item Modified Frailty Index (mFI-5) demonstrated a statistical association with an increase in the odds of in-hospital/30-day mortality (OR:1.97,95%CI: 1.55-2.49, p < 0.01). The pooled CCI results demonstrated an increase in the odds for in-hospital/30-day mortality (OR:1.44,95%CI: 1.27-1.64, p < 0.01). Pooled results for co-morbidity indices utilizing a scale-based continuous predictor were significantly associated with an increase in the odds of in-hospital/30-day morbidity (OR:1.32, 95% CI: 1.20-1.46, p < 0.01). On pooled analysis, the categorical results showed a higher odd for in-hospital/30-day morbidity (OR:1.74,95% CI: 1.50-2.02, p < 0.01). The mFI-5 was significantly associated with severe complications (Clavien-Dindo ≥ III) (OR:3.31,95% CI:1.13-9.67, p < 0.04). Pooled results for CCI showed a positive trend toward severe complications but were not significant.

CONCLUSION

The contemporary frailty-based index, mFI-5, outperformed the CCI in predicting short-term mortality and severe complications post-surgically. Risk stratification instruments that include a measure of frailty may be more predictive of surgical outcomes compared to traditional indices like the CCI.

Impact of Patient Frailty on Speech Recognition and Quality of Life Outcomes in Adult Cochlear Implant Users

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.

Exploration of Risk Factors for Poor Prognosis of Non-Traumatic Non-Aneurysmal Subarachnoid Hemorrhage

Background: Subarachnoid hemorrhage (SAH) is a devastating neurological disease associated with high rates of mortality and disability. Aneurysms are the main cause of non-traumatic subarachnoid hemorrhages. However, non-traumatic non-aneurysmal subarachnoid hemorrhage (naSAH), another clinical type of SAH, has been poorly studied for its prognosis and risk factors. Method and result: We collected demographic and clinical variables for 126 naSAH and 89 aneurysmal subarachnoid hemorrhage (aSAH) patients, including age and gender; hospitalization days; hematological indicators; clinical score scales; past medical history; and personal history. We found that the monocytes in naSAH (0.50 ± 0.26) patients were lower than in aSAH patients (0.60 ± 0.27). The prevalence of diabetes in naSAH (30.2%) patients was higher than in aSAH (14.5%) patients. The naSAH patients were divided into good and poor outcome groups based on the modified Rankin Scale at the 90th day (90-day mRS) after discharge. A univariate analysis showed that there were significant differences in age, white blood cell count (WBC), monocyte count, D-dipolymer, neuron-specific enolase (NSE), random blood glucose (RBG), aspartate transaminase (AST), urea and free triiodothyronine (FT3) between the two groups. A logistic regression showed that aging and high level NSE were independent risk factors for a poor outcome. The predictive ability of age (area under curve (AUC) = 0.71) and NSE (AUC = 0.68) were analyzed by a receiver operating characteristic (ROC) curve. The results of the logistic regression suggested that age, D-dipolymer, NSE, RBG, urea and FT3 distinguished and predicted the prognosis of naSAH. The discriminant analysis of the above variables revealed that the discriminant accuracy was 80.20%. Conclusions: Compared with aSAHs, naSAHs are more likely to occur in patients with diabetes, and the level of monocytes is lower. Moreover, the prognosis of elderly patients with an naSAH is relatively poor, and the level of NSE in the course of the disease also reflects the prognosis. Multivariate comprehensive analysis is helpful to judge the prognosis of patients at a small cost.

Demographics and Outcomes of Interhospital Transfer Patients Undergoing Intracranial Tumor Resection: A Retrospective Cohort Analysis

Introduction

Interhospital transfer (IHT) contributes to increasing health care costs and typically accounts for increased patient morbidity and mortality compared to non-IHT patients. IHT inefficiencies leave patients vulnerable to delayed care and subsequent poor outcomes. In this study, we investigated factors influencing IHT of patients undergoing intracranial tumor resection (ITR), by comparing the variables distinguishing IHTs from non-IHT patients.

Methods

We performed a single-center retrospective review comparing IHT and non-IHT patients undergoing ITR from 2016 to 2018. Study variables included age, sex, race, the Milan Complexity Scale (MCS) score, 11-factor modified frailty index (mFI-11), length of stay (LOS), and Clavien-Dindo Score (CDS). Chi-square and Mann-Whitney U tests were used to identify significant differences in these variables between groups, while variables predictive of transfer status were identified using binary logistic regression.

Results

Data were collected from 219 patients undergoing ITR, with 80 (36.5%) IHT patients overall. The average age was 52 years (SD 18) and 57.7% were men. The MCS score was significantly higher in the IHT group (p = 0.014); however, mFI-11 was not (p = 0.322). The MCS score was predictive of IHT status in regression analysis (OR 1.17, p = 0.034). The IHT patients had a longer LOS (12 days vs 8 days, p = 0.014) with a lower CDS (p = 0.02).

Conclusion

The transfer patients for intracranial tumor resection had a higher MCS score and thus comprised a more surgically challenging population compared to non-transfer patients. As expected, IHT patients had a longer LOS as they lived further from hospital by definition.