No abstract

Background: 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.

Introduction:Many patients within the orthopaedic population experience 1 or more psychosocial issues that may profoundly affect their postoperative outcomes after orthopaedic surgery. Despite the common nature of these factors, there is a paucity of literature describing their effect on orthopaedic outcomes. The purpose of this review was to describe the anecdotal 10 most-encountered psychosocial factors in our patient population, their described influence on orthopaedic outcomes, and how they may be addressed. These factors include expectations, fear of reinjury, socioeconomic status, social support, allergies, addiction, depression and anxiety, resilience, self-efficacy, and other mental health disorders.Methods:A thorough review of the PubMed-indexed literature was conducted using each one of our psychosocial factors described here combined with the key words “orthopaedic outcome.”Study Design:This was a clinical review paper.Level of Evidence:Not applicable.Results:These 10 psychosocial influences have dramatic effects on the recovery and outcomes after orthopaedic procedures. Patients benefit from early recognition and management of these issues before and after surgery.Conclusions:Each of the psychosocial factors reviewed in this paper has a significant influence on outcomes after orthopaedic surgery. A strong understanding of these factors and how to address them will aid orthopaedic surgeons in maximizing postoperative outcomes for their patients. Further research is necessary to improve our treatment strategies for this complex patient population.