Increasing Frailty, Not Increasing Age, Results in Increased Length of Stay Following Vestibular Schwannoma Surgery

Abstract

Objective: Understand the frailty of vestibular schwannoma surgical patients and how frailty impacts clinical course. Study Design: Retrospective Cohort. Setting: Single-tertiary academic hospital. Patients: All patients undergoing vestibular schwannoma surgery. Intervention: The modified frailty index (mFI) was calculated for all patients undergoing surgery for vestibular schwannoma between 2011 and 2018. Patient demographics and medical history, perioperative course, and postoperative complications were obtained from the medical record. Main Outcome Measures: The primary endpoint was hospital length of stay (LOS). Secondary endpoint was postoperative complications. Basic statistical analysis was performed including multivariate linear regressions to determine independent predictors of LOS. Results: There were 218 patients included and the mean age was 48.1 ± 0.9 (range 12–77). One-hundred ten patients were male (50.5%). The mean ICU LOS was 1.6 ± 0.1 days while mean total hospital LOS was 4.3 ± 0.2. There were 145 patients (66.5%) who were robust (nonfrail) with an mFI of 0, while 73 (33.5%) had an mFI of ≥1. Frailty (mFI≥2) was associated with longer hospital LOS compared with the prefrail (p = 0.0014) and robust (p = 0.0004) groups, but was not associated with increased complications (OR = 1.3; 95% CI: 0.5–3.7; p = 0.5925) or ICU LOS (p > 0.05). In multivariate analysis, increased mFI, and NOT increased age, was an independent risk factor for increased hospital LOS (p = 0.027). Conclusion: Increasing frailty, and not increasing age, is an independent risk factor for longer hospital LOS, but not for increased postoperative complications. Patients’ frailty status may be useful preoperatively in counselling patients about postoperative expectations and frail vestibular schwannoma patients may require increased health spending costs given their increased hospital LOS.

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

“…These findings parallel those of Dicpinigaitis et al and Casazza et al, which analyzed VS outcomes in the NIS and a singleinstitution case series, respectively. 1,9 However, our findings extend these results by not only validating these associations for mFI-5 and CCI but also comparing all 3 metrics. Although mFI-11 and CCI were demonstrated to have higher discriminatory power than mFI-5, these metrics require twice as many clinical variables, which may limit practical clinical utility.…”

Association Between 5‐Item Modified Frailty Index and Short‐term Outcomes in Complex Head and Neck Surgery

“…Despite this limitation, there have been emerging studies that similarly demonstrate the validity of the mFI as a predictor of postoperative adverse events using institutional patient data. 44,51,52 Second, our database was limited to 30-day outcomes, and thus long-term events were not captured. Third, the surgical/medical complications captured by the ACS-NSQIP database are generalized across all specialties, and thus certain head and neck–specific complications (eg, nerve injury) were not included, although the focus of frailty indices is generally upon larger-scale events (eg, cardiac or pulmonary).…”

Frailty and Quality of Life After Cochlear Implantation in Older Adults

“…12,26,27 Our group has also collaborated on a project using the frailty index to evaluate risk for complications in cerebropontine angle tumors. 28…”