Impact of Frailty on Outcomes Following Spine Surgery: A Prospective Cohort Analysis of 668 Patients

Agarwal, Nitin; Goldschmidt, Ezequiel; Taylor, Tavis; Roy, Souvik; Dunn, Stefanie C Altieri; Bilderback, Andrew; Friedlander, Robert M.; Kanter, Adam S.; Okonkwo, David O.; Gerszten, Peter C.; Hamilton, D. Kojo; Hall, Daniel E.

doi:10.1093/neuros/nyaa468_s103

Cited by 8 publications

(19 citation statements)

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“…Although all 3 frailty scores analyzed in this study have been widely used as predictors of neurosurgical outcomes, a key drawback in using these frailty metrics for neurosurgery is that their scoring components are not specific to neurosurgical disease processes. 7,19,32,35,36 A notable example is mFI-5 because its 5 variables were chosen primarily on the basis of being available in the National Surgical Quality Improvement Program database, as opposed to any formal clinical rationale. 11 Our custom 5-variable vestibular schwannoma risk score (VS-5, https://skullbaseresearch.shinyapps.io/vs-5_calculator/), generated using machine learning–based model selection, outperformed patient age and all 3 frailty indices in predicting routine hospital discharge.…”

Section: Discussionmentioning

confidence: 99%

“…17,18 In-hospital mortality was not chosen as the primary end point for this study because of being present in <0.5% of the study population, creating the risk of model overfitting. 19 We calculated the "high frailty" threshold for each score by determining the point on its corresponding ROC curve at which the Youden Index (sum of sensitivity and specificity) was maximized. 9 This threshold was ≥2 for all 3 scores.…”

Section: Frailty Scoresmentioning

confidence: 99%

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Association of Patient Frailty With Vestibular Schwannoma Resection Outcomes and Machine Learning Development of a Vestibular Schwannoma Risk Stratification Score

et al. 2022

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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)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017). Three risk stratification scores were analyzed: modified Frailty Index-5, modified Frailty , 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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Section: Discussionmentioning

confidence: 99%

Section: Frailty Scoresmentioning

confidence: 99%

Association of Patient Frailty With Vestibular Schwannoma Resection Outcomes and Machine Learning Development of a Vestibular Schwannoma Risk Stratification Score

et al. 2022

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“…Cervical deformity surgery is widely known to be associated with a large initial healthcare expenditures and a high rate of complications 21,26,27. Moreover, previous studies have shown frailty is commonly present among the population necessitating surgical correction for CD 28,29. While it is generally accepted that frailty is an important risk factor for adverse events following CD surgery, it is equally vital to define the influence of this spectrum disorder on costs of care.…”

Section: Discussionmentioning

confidence: 99%

The Additional Economic Burden of Frailty in Adult Cervical Deformity Patients Undergoing Surgical Intervention

Passias

Kummer

Williamson

et al. 2022

Spine

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Summary of Background Data. The influence of frailty on economic burden following corrective surgery for the adult cervical deformity (CD) is understudied and may provide valuable insights for preoperative planning. Objective. To assess the influence of baseline frailty status on the economic burden of CD surgery Study Design. Retrospective cohort. Materials and Methods. CD patients with frailty scores and baseline and two-year Neck Disability Index data were included. Frailty score was categorized patients by modified CD frailty index into not frail (NF) and frail (F). Analysis of covariance was used to estimate marginal means adjusting for age, sex, surgical approach, and baseline sacral slope, T1 slope minus cervical lordosis, C2–C7 angle, C2–C7 sagittal vertical axis. Costs were derived from PearlDiver registry data. Reimbursement consisted of a standardized estimate using regression analysis of Medicare payscales for services within a 30-day window including length of stay and death. This data is representative of the national average Medicare cost differentiated by complication/comorbidity outcome, surgical approach, and revision status. Cost per quality-adjusted life-year (QALY) at two years was calculated for NF and F patients. Results. There were 126 patients included. There were 68 NF patients and 58 classified as F. Frailty groups did not differ by overall complications, instance of distal junctional kyphosis, or reoperations (all P>0.05). These groups had similar rates of radiographic and clinical improvement by two years. NF and F had similar overall cost ($36,731.03 vs. $37,356.75, P=0.793), resulting in equivocal costs per QALYs for both patients at two years ($90,113.79 vs. $80,866.66, P=0.097). Conclusion. F and NF patients experienced similar complication rates and upfront costs, with equivocal utility gained, leading to comparative cost-effectiveness with NF patients based on cost per QALYs at two years. Surgical correction for CD is an economical healthcare investment for F patients when accounting for anticipated utility gained and cost-effectiveness following the procedure. Level of Evidence. III.

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“…e RAI score was recently adopted to predict outcomes following spine surgery with superior discriminative ability for postoperative morbidity/mortality. [1] However, neurosurgery patient populations are heterogeneous and thus warrant pathology-specific analyses (e.g., malignant glioma, meningioma, and cranial trauma) for validation and, if indicated, recalibration of RAI.…”

Section: Discussionmentioning

confidence: 99%

Advanced frailty assessment tool predicts successful awake craniotomy in a 92-year-old patient: A case report

Cole¹,

Varela²,

Rumalla³

et al. 2022

Surgical Neurology International

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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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Impact of Frailty on Outcomes Following Spine Surgery: A Prospective Cohort Analysis of 668 Patients

Cited by 8 publications

References 0 publications

Association of Patient Frailty With Vestibular Schwannoma Resection Outcomes and Machine Learning Development of a Vestibular Schwannoma Risk Stratification Score

Association of Patient Frailty With Vestibular Schwannoma Resection Outcomes and Machine Learning Development of a Vestibular Schwannoma Risk Stratification Score

The Additional Economic Burden of Frailty in Adult Cervical Deformity Patients Undergoing Surgical Intervention

Advanced frailty assessment tool predicts successful awake craniotomy in a 92-year-old patient: A case report

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