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Covell MM, Roy JM, Gupta N, Raihane AS, Rumalla KC, Lima Fonseca Rodrigues AC, Courville E, Bowers CA. Frailty in intracranial meningioma resection: the risk analysis index demonstrates strong discrimination for predicting non-home discharge and in-hospital mortality. J Neurooncol 2024:10.1007/s11060-024-04703-5. [PMID: 38713325 DOI: 10.1007/s11060-024-04703-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Frailty is an independent risk factor for adverse postoperative outcomes following intracranial meningioma resection (IMR). The role of the Risk Analysis Index (RAI) in predicting postoperative outcomes following IMR is nascent but may inform preoperative patient selection and surgical planning. METHODS IMR patients from the Nationwide Inpatient Sample were identified using diagnostic and procedural codes (2019-2020). The relationship between preoperative RAI-measured frailty and primary outcomes (non-home discharge (NHD), in-hospital mortality) and secondary outcomes (extended length of stay (eLOS), complication rates) was assessed via multivariate analyses. The discriminatory accuracy of the RAI for primary outcomes was measured in area under the receiver operating characteristic (AUROC) curve analysis. RESULTS A total of 23,230 IMR patients (mean age = 59) were identified, with frailty statuses stratified by RAI score: 0-20 "robust" (R)(N = 10,665, 45.9%), 21-30 "normal" (N)(N = 8,895, 38.3%), 31-40 "frail" (F)(N = 2,605, 11.2%), and 41+ "very frail" (VF)(N = 1,065, 4.6%). Rates of NHD (R 11.5%, N 29.7%, F 60.8%, VF 61.5%), in-hospital mortality (R 0.5%, N 1.8%, F 3.8%, VF 7.0%), eLOS (R 13.2%, N 21.5%, F 40.9%, VF 46.0%), and complications (R 7.5%, N 11.6%, F 15.7%, VF 16.0%) significantly increased with increasing frailty thresholds (p < 0.001). The RAI demonstrated strong discrimination for NHD (C-statistic: 0.755) and in-hospital mortality (C-statistic: 0.754) in AUROC curve analysis. CONCLUSION Increasing RAI-measured frailty is significantly associated with increased complication rates, eLOS, NHD, and in-hospital mortality following IMR. The RAI demonstrates strong discrimination for predicting NHD and in-hospital mortality following IMR, and may aid in preoperative risk stratification.
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Affiliation(s)
- Michael M Covell
- School of Medicine, Georgetown University, 3900 Reservoir Road, 20007, Washington, DC, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, 84070, Sandy, UT, USA
| | - Joanna M Roy
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, 84070, Sandy, UT, USA
| | - Nithin Gupta
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | - Ahmed Sami Raihane
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, 84070, Sandy, UT, USA
| | - Kranti C Rumalla
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, 84070, Sandy, UT, USA
| | | | - Evan Courville
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, 84070, Sandy, UT, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, 84070, Sandy, UT, USA.
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Roy JM, Kazim SF, Macciola D, Rangel DN, Rumalla K, Karimov Z, Link R, Iqbal J, Riaz MA, Skandalakis GP, Venero CV, Sidebottom RB, Dicpinigaitis AJ, Kassicieh CS, Tarawneh O, Conlon MS, Thommen R, Alvarez-Crespo DJ, Chhabra K, Sridhar S, Gill A, Vellek J, Nguyen PA, Thompson G, Robinson M, Bowers CA. Frailty as a predictor of postoperative outcomes in neurosurgery: a systematic review. J Neurosurg Sci 2024; 68:208-215. [PMID: 37878249 DOI: 10.23736/s0390-5616.23.06130-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Baseline frailty status has been utilized to predict a wide range of outcomes and guide preoperative decision making in neurosurgery. This systematic review aims to analyze existing literature on the utilization of frailty as a predictor of neurosurgical outcomes. EVIDENCE ACQUISITION We conducted a systematic review following PRISMA guidelines. Studies that utilized baseline frailty status to predict outcomes after a neurosurgical intervention were included in this systematic review. Studies that utilized sarcopenia as the sole measure of frailty were excluded. PubMed, EMBASE, and Cochrane library was searched from inception to March 1st, 2023, to identify relevant articles. EVIDENCE SYNTHESIS Overall, 244 studies met the inclusion criteria. The 11-factor modified frailty index (mFI-11) was the most utilized frailty measure (N.=91, 37.2%) followed by the five-factor modified Frailty Index (mFI-5) (N.=80, 32.7%). Spine surgery was the most common subspecialty (N.=131, 53.7%), followed by intracranial tumor resection (N.=57, 23.3%), and post-operative complications were the most reported outcome (N.=130, 53.2%) in neurosurgical frailty studies. The USA and the Bowers author group published the greatest number of articles within the study period (N.=176, 72.1% and N.=37, 15.2%, respectively). CONCLUSIONS Frailty literature has grown exponentially over the years and has been incorporated into neurosurgical decision making. Although a wide range of frailty indices exist, their utility may vary according to their ability to be incorporated in the outpatient clinical setting.
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Affiliation(s)
- Joanna M Roy
- Topiwala National Medical College, Mumbai, India
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| | - Syed F Kazim
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Dylan Macciola
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Dante N Rangel
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Kavelin Rumalla
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Zafar Karimov
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Remy Link
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Javed Iqbal
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Muhammad A Riaz
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Georgios P Skandalakis
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | | | | | | | | | - Omar Tarawneh
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Matt S Conlon
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Rachel Thommen
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | | | - Karizma Chhabra
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Sahaana Sridhar
- Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - Amanpreet Gill
- Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - John Vellek
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Phuong A Nguyen
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Grace Thompson
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Myranda Robinson
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA -
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
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Demiraslan A, Çelikoğlu E, Hakan T, Hazneci J. Recurrence and Mortality Rate in a 42 Patient Cohort of Giant Meningiomas. World Neurosurg 2024:S1878-8750(24)00520-5. [PMID: 38570092 DOI: 10.1016/j.wneu.2024.03.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Giant meningiomas may show special features in terms of biological behavior and management. We aimed to research recurrence and mortality of giant meningiomas. METHODS Medical files of patients with meningioma with at least 1 dimension of ≥5 cm in any plane in radiological investigations between December 2012 and January 2022 were retrospectively reviewed. Tumor dimensions were measured on magnetic resonance images except 1. All patients except two underwent clinical follow-up at a mean of 27.19 ± 29.87 (range, 4-112) months. RESULTS There were 42 patients, 26 (61.9%) women and 16 (38.1%) men who ranged in age from 31 to 85 (mean, 60.31 ± 14.86) years. Headache (57.1%) was the most common symptom. The mean tumor size was 70.14 ± 19.03 (range, 50-152) mm. Tumors were most located at the frontal convexity (40.5%). Simpson grade I resection was achieved in 19% of the cases. The tumors were World Health Organization grade 1 in 74% and grade 2 in 26% of the cases. Major complications developed in 26.1% of the patients. Recurrence happened in 5 (11.9%) cases. The number of World Health Organization grade 2 tumors (P = 0.013; P < 0.05) and tumor size (P = 0.006; P < 0.01) were significantly higher in the recurrent cases. Mortality was % 11.9 and statistically significantly higher in the recurrence group (P = 0.025; P < 0.05). CONCLUSIONS Giant intracranial meningiomas are challenging because of surgical experience, tumor size, peritumoral edema, blood supply, anatomical changes, and limited visibility. They have a high risk of recurrence and mortality.
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Affiliation(s)
- Ali Demiraslan
- Şehit Kamil State Hospital, Neurosurgery Clinic, Gaziantep, Turkey
| | - Erhan Çelikoğlu
- Department of Neurosurgery, University of Health Sciences, Hamidiye Faculty of Medicine, Istanbul, Turkey; Fatih Sultan Mehmet Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Tayfun Hakan
- Department of Neurosurgery, University of Health Sciences, Hamidiye Faculty of Medicine, Istanbul, Turkey; Fatih Sultan Mehmet Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey.
| | - Jülide Hazneci
- Fatih Sultan Mehmet Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
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Stonnington H, Shahbandi A, Bcharah G, Singh R, George DD, Furst T, Krishna C, Bydon M. Timing and Morbidity of Intracranial Meningioma Resection Complications. World Neurosurg 2024; 183:e293-e303. [PMID: 38141757 DOI: 10.1016/j.wneu.2023.12.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Intracranial meningioma resection is associated with multiple acute postoperative complications, including cerebrovascular accidents, surgical site infections, and pneumonia. There is a paucity of research on the postoperative timeframe of these complications. Therefore, our objective is to characterize intracranial meningioma resection complications' time courses. METHODS The National Surgical Quality Improvement Project registry was queried for intracranial meningioma resection cases using CPT codes 61512 and 61519 from years 2016 to 2021. Baseline patient characteristics and 30-day complication frequency were calculated. The mean, median, and interquartile range of postoperative days to occurrence for 17 complications were calculated. Percent incidence predischarge was recorded. Time-to-occurrence curves were created. Rates of 30-day mortality and increased length-of-stay were compared between patients with and without each complication using a χ2 test. A covariance matrix showing associations between 11 complications using the Pearson method was made. Significance was set at P < 0.05. RESULTS Ten thousand eight hundred ninety cases were analyzed. The most frequent complications' median and interquartile range of postoperative days to occurrence and percentage occurring predischarge were bleeding requiring transfusion (0.0, 0.0-0.0, 99.9%), cerebrovascular accident/stroke with neurological deficit (2.0, 1.0-6.0, 83.8%), unplanned intubation (4.0, 1.0-8.0, 75.1%), on a ventilator for >48 hours (3.0; 2.0-5.5; 88.1%), deep vein thrombosis/thrombophlebitis (12.5, 5.2-19.7, 41.3%), urinary tract infection (13.0, 7.0-20.0, 44.2%), pneumonia (8.0, 4.0-16.0, 60.5%), and pulmonary embolism (14.0, 6.0-20.0, 29.1%). Most complications were associated with increased mortality and length-of-stay. CONCLUSIONS Postoperative meningioma resection complications have varying morbidity and timeframes. Surgeons should be aware of complication timing to better manage postoperative care.
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Affiliation(s)
| | | | - George Bcharah
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Rohin Singh
- Department of Neurosurgery, University of Rochester, Rochester, New York, USA
| | - Derek D George
- Department of Neurosurgery, University of Rochester, Rochester, New York, USA
| | - Taylor Furst
- Department of Neurosurgery, University of Rochester, Rochester, New York, USA
| | - Chandan Krishna
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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Welch C, Kazim SF, Esce A, Bowers C, Syme N, Boyd N. Frailty as a Predictor of Post-Surgical Outcomes in Patients With Cutaneous Malignancies of the Scalp and Neck Requiring Flap Reconstruction. Ann Otol Rhinol Laryngol 2024; 133:7-13. [PMID: 37345503 DOI: 10.1177/00034894231180959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Investigate the ability of frailty status to predict post-surgical outcomes in patients with cutaneous malignancies of the scalp and neck undergoing flap reconstruction. METHODS National Surgical Quality Improvement Program database was used to isolate patients with cutaneous malignancies of the scalp and neck who underwent surgical resection between 2015 to 2019. Univariate and multivariate analyses were performed to determine if frailty score correlated with negative post-operative outcomes. Receiver operating characteristic (ROC) curves allowed testing of the discriminative performance of age versus frailty. RESULTS This study demonstrated an independent correlation between frailty and major complications as well as non-home discharge. In ROC curve analysis, frailty demonstrated superior discrimination compared to age for predicting major complications. CONCLUSION Our study demonstrated an association between increasing frailty and major complications as well as the likelihood of a non-home discharge. When compared to age, frailty was also shown to be a better predictor of major complications.
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Affiliation(s)
- Christopher Welch
- Department of Surgery, Division of Otolaryngology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Antoinette Esce
- Department of Surgery, Division of Otolaryngology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Christian Bowers
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Noah Syme
- Department of Surgery, Division of Otolaryngology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Nathan Boyd
- Department of Surgery, Division of Otolaryngology, University of New Mexico School of Medicine, Albuquerque, NM, USA
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Hu X, Ma Y, Jiang X, Tang W, Xia Y, Song P. Neurosurgical perioperative management of frail elderly patients. Biosci Trends 2023; 17:271-282. [PMID: 37635083 DOI: 10.5582/bst.2023.01208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
With the rapid increase in global aging, the prevalence of frailty is increasing and frailty has emerged as an emerging public health burden. Frail elderly patients suffer from reduced homeostatic reserve capacity, which is associated with a disproportionate decline in physical status after exposure to stress and an increased risk of adverse events. Frailty is closely associated with changes in the volume of the white and gray matter of the brain. Sarcopenia has been suggested to be an important component of frailty, and reductions in muscle strength and muscle mass lead to reductions in physical function and independence, which are critical factors contributing to poor prognosis. Approximately 10-32% of patients undergoing neurological surgery are frail, and the risk of frailty increases with age, which is significantly associated with the occurrence of adverse postoperative events (major complications, total duration of hospitalization, and need for discharge to a nursing facility). The postoperative mortality rate in severely frail patients is 9-11 times higher than that in non-frail individuals. Therefore, due attention must be paid to neurosurgical frailty and muscle assessment in elderly patients. Specialized interventions in the perioperative period of neurosurgery in frail elderly patients may improve their postoperative prognosis.
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Affiliation(s)
- Xiqi Hu
- Department of Neurosurgery, Haikou Affiliated Hospital of Central South University Xiangya School of Medicine Haikou, China
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yanan Ma
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Gastroenterology, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Xuemei Jiang
- Department of Gastroenterology, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Wei Tang
- International Health Care Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ying Xia
- Department of Neurosurgery, Haikou Affiliated Hospital of Central South University Xiangya School of Medicine Haikou, China
| | - Peipei Song
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Cole KL, Findlay MC, Earl E, Sherrod BA, Cutler CB, Nguyen S, Grandhi R, Menacho ST. Understanding the Unique Challenges Faced by Homeless Patients With Acute Traumatic Neurosurgical Injuries. Neurosurgery 2023; 93:292-299. [PMID: 36892284 DOI: 10.1227/neu.0000000000002408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/14/2022] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Homelessness is associated with high risk of acute neurotraumatic injury in the ∼600 000 Americans affected on any given night. OBJECTIVE To compare care patterns and outcomes between homeless and nonhomeless individuals with acute neurotraumatic injuries. METHODS Adults hospitalized for acute neurotraumatic injuries between January 1, 2015, and December 31, 2020, were identified in this retrospective cross-sectional study at our Level 1 trauma center. We evaluated demographics, in-hospital characteristics, discharge dispositions, readmissions, and adjusted readmission risk. RESULTS Of 1308 patients, 8.5% (n = 111) were homeless on admission to neurointensive care. Compared with nonhomeless individuals, homeless patients were younger ( P = .004), predominantly male ( P = .003), and less frail ( P = .003) but had similar presenting Glasgow Coma Scale scores ( P = .85), neurointensive care unit stay time ( P = .15), neurosurgical interventions ( P = .27), and in-hospital mortality ( P = .17). Nevertheless, homeless patients had longer hospital stays (11.8 vs 10.0 days, P = .02), more unplanned readmissions (15.3% vs 4.8%, P < .001), and more complications while hospitalized (54.1% vs 35.8%, P = .01), particularly myocardial infarctions (9.0% vs 1.3%, P < .001). Homeless patients were mainly discharged to their previous living situation (46.8%). Readmissions were primarily for acute-on-chronic intracranial hematomas (4.5%). Homelessness was an independent predictor of 30-day unplanned readmissions (odds ratio 2.41 [95% CI 1.33-4.38, P = .004]). CONCLUSION Homeless individuals experience longer hospital stays, more inpatient complications such as myocardial infarction, and more unplanned readmissions after discharge compared with their housed counterparts. These findings combined with limited discharge options in the homeless population indicate that better guidance is needed to improve the postoperative disposition and long-term care of this vulnerable patient population.
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Affiliation(s)
- Kyril L Cole
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | - Emma Earl
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Brandon A Sherrod
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Christopher B Cutler
- College of Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Sarah Nguyen
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Sarah T Menacho
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Estes EM, Asserson DB, Kazim SF, Kogan M, Rumalla K, Spader HS, Botros JA, Schmidt MH, Bowers CA. Baseline frailty status, not advanced patient age, predicts epilepsy surgery outcomes: An analysis of 696 patients from the NSQIP database. Clin Neurol Neurosurg 2023; 231:107864. [PMID: 37390568 DOI: 10.1016/j.clineuro.2023.107864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/01/2023] [Accepted: 06/25/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE Preoperative risk stratification of patients undergoing epilepsy surgery remains challenging. Recently, the efforts to look beyond age alone as an outcomes predictor has resulted in the development of measures of physiological reserve, or 'frailty indices.' The most frequently cited index in neurosurgery is the 11-item or 5-item modified frailty index (mFI11 or mFI-5). The present study aimed to use a large national registry to evaluate the effect of frailty (as measured by mFI-5 versus age on postoperative outcomes of patients undergoing epilepsy surgery. METHODS The National Surgical Quality Improvement Program (NSQIP) database, overseen by the American College of Surgeons (ACS), was used to extract data for patients undergoing epilepsy surgery from 2015 to 2019. Univariate and multivariate analyses for age and mFI-5 were performed for the following 30-day outcomes of extended length of hospital stay (eLOS) and non-home discharge (NHD). The effect sizes were summarized by odds ratio and associated 95 % confidence intervals. Receiver operating characteristic (ROC) curve analysis, including area under the curve (AUC), was used to quantify the discrimination. RESULTS Univariate and multivariate analyses demonstrated that frailty statuses from mFI-5, not age, were significantly predictive of eLOS and NHD. On ROC curve analysis, mFI-5 was a stronger predictor of eLOS (C = 0.59, 95 % CI 0.54-0.64, p < 0.001) and NHD (C = 0.69, 95 % CI 0.64-0.76, p < 0.001) than age (C = 0.53, 95 % CI 0.48-0.58, p = 0.21 and C = 0.53, 95 % CI 0.46-0.59, p = 0.44, respectively). CONCLUSION Frailty, not age, is an independent risk factor for poor postoperative outcomes, particularly eLOS and NHD, in patients undergoing epilepsy surgery. Usage of mFI-5 for preoperative risk stratification of epilepsy surgery patients can help in prognostication.
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Affiliation(s)
- Emily M Estes
- Texas Tech University Health Sciences Center School of Medicine, El Paso, TX, United States of America
| | - Derek B Asserson
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, United States of America
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, United States of America
| | - Michael Kogan
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, United States of America
| | - Kavelin Rumalla
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, United States of America
| | - Heather S Spader
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, United States of America
| | - James A Botros
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, United States of America
| | - Meic H Schmidt
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, United States of America
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, United States of America.
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11
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Moya AN, Owodunni OP, Harrison JL, Shahriari SR, Shetty AK, Borah GL, Schmidt MH, Bowers CA. Preoperative Frailty Risk in Cranioplasty Patients: Risk Analysis Index Predicts Adverse Outcomes. Plast Reconstr Surg Glob Open 2023; 11:e5059. [PMID: 37351116 PMCID: PMC10284328 DOI: 10.1097/gox.0000000000005059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/19/2023] [Indexed: 06/24/2023]
Abstract
Cranioplasty is a common surgical procedure used to repair cranial defects, and it is associated with significant morbidity and mortality. Although frailty is a strong predictor of poor postoperative outcomes across surgical specialties, little is known about frailty's impact on cranioplasty outcomes. This study examined the association between frailty and cranioplasty by comparing the effect of the Risk Analysis Index-Administrative (RAI-A) and the Modified Frailty Index-5 (mFI-5) on cranioplasty outcomes. Methods The National Surgical Quality Improvement Program was queried for patients undergoing cranioplasty between 2012 and 2020. Receiver operating characteristics and multivariable analyses were used to assess the relationship of postoperative outcomes and the RAI-A, mFI-5, and increasing patient age. Results There were 2864 included study patients with a median age of 57 years (IQR, 44-67), and a higher proportion of patients were women (57.0%) and White (68.5%). The RAI-A had a more robust predictive ability for 30-day mortality (C-Statistic, 0.741; 95% confidence interval (CI), 0.678-0.804) compared with mFI-5 (C-Statistic, 0.574; 95% CI, 0.489-0.659) and increasing patient age (C-Statistic, 0.671; 95% CI, 0.610-0.732). On multivariable analyses, frailty was independently associated with mortality and other poor postoperative outcomes (P < 0.05). Conclusions The RAI-A demonstrated superior discrimination than the mFI-5 and increasing patient age in predicting mortality. Additionally, the RAI-A showed independent associations with nonhome discharge and postoperative complications (CDII, CDIIIb, and CDIV). The high rates of operative morbidity (5.0%-36.5%) and mortality (0.4%-3.2%) after cranioplasty highlight the importance of identifying independent risk factors for poor cranioplasty outcomes.
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Affiliation(s)
- Addi N. Moya
- From the University of New Mexico School of Medicine, Albuquerque, N.M
| | - Oluwafemi P. Owodunni
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, N.M
| | - Joshua L. Harrison
- Department of Surgery, Division of Plastic, Reconstructive, Hand and Burn Surgery, University of New Mexico School of Medicine, Albuquerque, N.M
| | - Shawhin R. Shahriari
- Department of Surgery, Division of Plastic, Reconstructive, Hand and Burn Surgery, University of New Mexico School of Medicine, Albuquerque, N.M
| | - Anil K. Shetty
- Department of Surgery, Division of Plastic, Reconstructive, Hand and Burn Surgery, University of New Mexico School of Medicine, Albuquerque, N.M
| | - Gregory L. Borah
- Department of Surgery, Division of Plastic, Reconstructive, Hand and Burn Surgery, University of New Mexico School of Medicine, Albuquerque, N.M
| | - Meic H. Schmidt
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, N.M
| | - Christian A. Bowers
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, N.M
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12
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Roy JM, Kazim SF, Schmidt MH, Bowers CA. Letter: Frailty-Based Prehabilitation for Patients Undergoing Intracranial Meningioma Resection. Neurosurgery 2023; 92:e142-e144. [PMID: 37184265 DOI: 10.1227/neu.0000000000002487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 04/07/2023] Open
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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14
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Abou Chawareb E, Ayoub CH, Najdi J, Ghoubaira J, El-Hajj A. Preoperative predictors of prolonged length of stay in radical cystectomy: a retrospective study using the American College of Surgeons-National Surgical Quality Improvement Program Dataset. Ther Adv Urol 2023; 15:17562872231191654. [PMID: 37577029 PMCID: PMC10413889 DOI: 10.1177/17562872231191654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
Background Radical cystectomy (RC) is considered a complex procedure that entails significant morbidity and mortality. Objectives We aimed to determine pre-operative patient characteristics that help predict a prolonged length of hospital stay (PLOS) following RC. Design and Methods The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was used to select patients who underwent RC between the years 2011 and 2020. Prolonged length of stay was defined as a hospital stay ⩾9 days. We compared patient demographics, pre-operative labs, surgical characteristics, and medical history between patients with or without PLOS. Multivariable logistic regression models controlling for pre-operative characteristics and propensity score matching for post-operative complications were conducted to control for possible confounders. Results The analysis yielded details of 19,158 RC patients of which 6007 (31%) patients had a PLOS. Patients with PLOS were more likely to have post-operative complications that could serve as predictors for the PLOS rather than their pre-operative characteristics. Hence, we matched our cohort for these complications. After matching, patient pre-operative characteristics that predict PLOS included female gender (Odds Ratio (OR) = 5.91), 10-year increase in age (OR = 1.15), non-White race (OR = 1.98), partially or totally dependent functional health status (OR = 2.86), bleeding disorders (OR = 4.67), congestive heart failure (OR = 1.59), pre-operative transfusion (OR = 3.03), and a 20-min increase in operative time (OR = 1.01) (p < 0.046). Conclusion Patient demographics and pre-operative factors can help predict PLOS in RC patients. These predictors could serve as tools for patient counseling and risk stratification.
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Affiliation(s)
- Elia Abou Chawareb
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christian Habib Ayoub
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jad Najdi
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joseph Ghoubaira
- Department of Radiology Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Albert El-Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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Thommen R, Kazim SF, Rumalla K, Kassicieh AJ, Kalakoti P, Schmidt MH, McKee RG, Hall DE, Miskimins RJ, Bowers CA. Preoperative frailty measured by risk analysis index predicts complications and poor discharge outcomes after Brain Tumor Resection in a large multi-center analysis. J Neurooncol 2022; 160:285-297. [PMID: 36316568 DOI: 10.1007/s11060-022-04135-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/14/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the independent effect of frailty, as measured by the Risk Analysis Index-Administrative (RAI-A) for postoperative complications and discharge outcomes following brain tumor resection (BTR) in a large multi-center analysis. METHODS Patients undergoing BTR were queried from the National Surgical Quality Improvement Program (NSIQP) for the years 2015 to 2019. Multivariable logistic regression was performed to evaluate the independent associations between frailty tools (age, 5-factor modified frailty score [mFI-5], and RAI-A) on postoperative complications and discharge outcomes. RESULTS We identified 30,951 patients who underwent craniotomy for BTR; the median age of our study sample was 59 (IQR 47-68) years old and 47.8% of patients were male. Overall, increasing RAI-A score, in an overall stepwise fashion, was associated with increasing risk of adverse outcomes including in-hospital mortality, non-routine discharge, major complications, Clavien-Dindo Grade IV complication, and extended length of stay. Multivariable regression analysis (adjusting for age, sex, BMI, non-elective surgery status, race, and ethnicity) demonstrated that RAI-A was an independent predictor for worse BTR outcomes. The RAI-A tiers 41-45 (1.2% cohort) and > 45 (0.3% cohort) were ~ 4 (Odds Ratio [OR]: 4.3, 95% CI: 2.1-8.9) and ~ 9 (OR: 9.5, 95% CI: 3.9-22.9) times more likely to have in-hospital mortality compared to RAI-A 0-20 (34% cohort). CONCLUSIONS AND RELEVANCE Increasing preoperative frailty as measured by the RAI-A score is independently associated with increased risk of complications and adverse discharge outcomes after BTR. The RAI-A may help providers present better preoperative risk assessment for patients and families weighing the risks and benefits of potential BTR.
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Affiliation(s)
- Rachel Thommen
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA
| | - Syed Faraz Kazim
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87131, USA
| | - Kavelin Rumalla
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87131, USA
| | - Alexander J Kassicieh
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87131, USA
| | - Piyush Kalakoti
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Meic H Schmidt
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87131, USA
| | - Rohini G McKee
- Department of Surgery, University of New Mexico Hospital (UNMH), Albuquerque, NM 87131, USA
| | - Daniel E Hall
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Wolff Center at UPMC, Pittsburgh, PA, USA
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Richard J Miskimins
- Department of Surgery, University of New Mexico Hospital (UNMH), Albuquerque, NM 87131, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA.
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87131, USA.
- Department of Neurosurgery MSC10 5615, University of New Mexico, Albuquerque, NM 81731, USA.
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Ren L, Cheng H, Chen J, Deng J, Wang D, Xie Q, Wakimoto H, Hua L, Gong Y. Progesterone receptor expression and prediction of benefits of adjuvant radiotherapy in de novo atypical meningiomas after gross-total resection. J Neurosurg 2022:1-10. [DOI: 10.3171/2022.9.jns221530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Benefits of adjuvant radiotherapy (ART) after gross-total resection (GTR) of de novo atypical meningiomas (AMs) are controversial, and factors predictive of radiotherapy benefits in patients with de novo AMs after GTR are unknown. The authors aimed to evaluate the benefits of ART and explore potential factors sensitizing AMs to ART.
METHODS
A total of 231 consecutive patients who were pathologically diagnosed with de novo AMs and treated with GTR (Simpson class I–III resections) from 2010 to 2018 were enrolled in the study. Clinicopathological and prognostic information was collected and analyzed. Univariate and multivariate Cox analyses were used to evaluate prognostic predictors and compare the response to radiotherapy. Propensity score matching (PSM) was used to balance the confounding bias in subgroups.
RESULTS
A total of 138 patients (59.74%) received ART. Progesterone receptor (PR) expression was positive in 157 patients (67.97%). During the mean follow-up period of 76.25 months, 65 patients (28.14%) experienced recurrence and 38 (16.45%) died of tumor progression. For disease-specific survival (DSS), ART was a better prognostic factor via univariate (p = 0.003) and multivariate (p = 0.025) analyses. For progression-free survival (PFS), univariate Cox analysis showed that ART improved PFS (p = 0.013), but multivariate analysis did not (p = 0.068). Positive PR expression (p = 0.019), age 53.5 years or younger (p = 0.012), and Ki-67 7.5% or lower (p = 0.025) were independent prognostic predictors for better PFS. In the subcohort analysis, the beneficial impact of ART was observed in the PR-negative cohort (p = 0.002) but not in the PR-positive cohort (p = 0.86). The heterogeneity analysis demonstrated that the PR-negative cohort was more sensitive to ART than the PR-positive cohort (p = 0.036). ART was not found to be associated with better PFS in younger patients (≤ 53.5 years, p = 0.14), older patients (> 53.5 years, p = 0.085), those with a Ki-67 index ≤ 7.5% (p = 0.068), or those with a Ki-67 > 7.5% (p = 0.13). The contrasting effects of ART in the PR-negative versus PR-positive cohorts remained true even after PSM, confirming that PR-negative, but not PR-positive, de novo AMs benefited from ART after GTR.
CONCLUSIONS
ART was an independent prognostic factor for DSS of patients with de novo AMs treated with GTR (p = 0.025), but not for PFS (p = 0.068). Negative PR expression was a radiosensitive biomarker on PFS for de novo AM patients after GTR.
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Affiliation(s)
- Leihao Ren
- Departments of Neurosurgery,
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China; and
| | | | - Jiawei Chen
- Departments of Neurosurgery,
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China; and
| | - Jiaojiao Deng
- Departments of Neurosurgery,
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China; and
| | - Daijun Wang
- Departments of Neurosurgery,
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China; and
| | - Qing Xie
- Departments of Neurosurgery,
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China; and
| | - Hiroaki Wakimoto
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lingyang Hua
- Departments of Neurosurgery,
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China; and
| | - Ye Gong
- Departments of Neurosurgery,
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China; and
- Pathology, and
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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18
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Cole KL, Kurudza E, Rahman M, Kazim SF, Schmidt MH, Bowers CA, Menacho ST. Use of the 5-Factor Modified Frailty Index to Predict Hospital-Acquired Infections and Length of Stay Among Neurotrauma Patients Undergoing Emergent Craniotomy/Craniectomy. World Neurosurg 2022; 164:e1143-e1152. [PMID: 35659593 DOI: 10.1016/j.wneu.2022.05.122] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Traumatic brain injury is a significant public health concern often complicated by hospital-acquired infections (HAIs); however, previous evaluations of factors predictive of risk for HAI have generally been single-center analyses or limited to surgical site infections. Frailty assessment has been shown to provide effective risk stratification in neurosurgery. We evaluated whether frailty status or age is more predictive of HAIs and length of stay among neurotrauma patients requiring craniectomy/craniotomy. METHODS In this cross-sectional analysis, the American College of Surgeons National Surgical Quality Improvement Program 2015-2019 dataset was queried to identify neurotrauma patients who underwent craniectomies/craniotomies. The effects of frailty status (using the 5-factor modified frailty index [mFI-5]) and age on occurrence of HAIs and other 30-day adverse events were compared using univariate analysis. The discriminative ability of each measure was defined by multivariate modeling. RESULTS Of 3284 patients identified, 1172 (35.7%) contracted an HAI postoperatively. Increasing frailty score predicted increased HAI risk (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.05-1.77, P = 0.022 for mFI-5 = 1 and OR = 2.01, 95% CI = 1.30-3.11, P = 0.002 for mFI-5≥3), whereas increasing age did not (OR = 0.996, 95% CI = 0.989-1.002, P = 0.009). Median length of stay was significantly longer in patients with HAI (16 days [IQR = 9-23]) versus no HAI (7 days [IQR = 4-13]) (P < 0.001). Median daily costs on the ward and neuro-intensive care unit were higher with HAI than with no HAI (neuro-ICU: $111,818.08 [IQR = 46,418.05-189,947.34] vs. $48,920.41 [IQR = 20,185.20-107,712.54], P < 0.001). CONCLUSIONS Increasing mFI-5 correlated with increased HAI risk. Neurotrauma patients who developed an HAI after craniectomy/craniotomy had longer hospitalizations and higher care costs. Frailty scoring improves risk stratification among these patients and may assist in reducing total hospital length of stay and total accrued costs to patients.
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Affiliation(s)
- Kyril L Cole
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Elena Kurudza
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Masum Rahman
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico, New Mexico, USA
| | - Meic H Schmidt
- Department of Neurosurgery, University of New Mexico, New Mexico, USA
| | | | - Sarah T Menacho
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
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