Letter: Beyond Risk Assessment: A New Vision for Transdisciplinary Frailty Care Coordination in Neurosurgery

Owodunni, Oluwafemi P.; Bowers, Christian A.

doi:10.1227/neu.0000000000002651

Cited by 3 publications

(4 citation statements)

References 5 publications

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“…As a more comprehensive frailty evaluation, it is not surprising that RAI showed better discrimination than mFI‐5 in predicting postoperative poor outcomes 46 . The integration of preoperative frailty screening faces hurdles both on a systems and individual level 47 . Yet, the potential benefits to patient care are profound.…”

Section: Discussionmentioning

confidence: 99%

“…46 The integration of preoperative frailty screening faces hurdles both on a systems and individual level. 47 Yet, the potential benefits to patient care are profound. Collaboration is key, and forging transdisciplinary partnerships can catalyze the translation of our study's benefits into routine practice.…”

Section: Variablesmentioning

confidence: 99%

“…Collaboration is key, and forging transdisciplinary partnerships can catalyze the translation of our study's benefits into routine practice. 47 Challenges are undeniable, but with strategic measures, they're surmountable, making the widespread adoption not just feasible, but transformative for patient outcomes. 47,48 Our study has several limitations which warrant discussion.…”

Section: Variablesmentioning

confidence: 99%

“…47 Challenges are undeniable, but with strategic measures, they're surmountable, making the widespread adoption not just feasible, but transformative for patient outcomes. 47,48 Our study has several limitations which warrant discussion. First, the hospitals in the ACS-NSQIP database may not be representative of all hospitals in the United States.…”

Section: Variablesmentioning

confidence: 99%

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The risk analysis index demonstrates exceptional discrimination in predicting frailty's impact on neurosurgical length of stay quality metrics

Gagliardi,

Conti,

Courville

et al. 2023

World j. surg.

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BackgroundQuality measures determine reimbursement rates and penalties in value‐based payment models. Frailty impacts these quality metrics across surgical specialties. We compared the discriminatory thresholds for the risk analysis index (RAI), modified frailty index‐5 (mFI‐5) and increasing patient age for the outcomes of extended length of stay (LOS [eLOS]), prolonged LOS within 30 days (pLOS), and protracted LOS (LOS > 30).MethodsPatients ≥18 years old who underwent neurosurgical procedures between 2012 and 2020 were queried from the ACS‐NSQIP. We performed receiver operating characteristic analysis, and multivariable analyses to examine discriminatory thresholds and identify independent associations.ResultsThere were 411,605 patients included, with a median age of 59 years (IQR, 48–69), 52.2% male patients, and a white majority 75.2%. For eLOS: RAI C‐statistic 0.653 (95% CI: 0.652–0.655), versus mFI‐5 C‐statistic 0.552 (95% CI: 0.550–0.554) and increasing patient age C‐statistic 0.573 (95% CI: 0.571–0.575). Similar trends were observed for pLOS‐ RAI: 0.718, mFI‐5: 0.568, increasing patient age: 0.559, and for LOS>30‐ RAI: 0.714, mFI‐5: 0.548, and increasing patient age: 0.506. Patients with major complications had eLOS 10.1%, pLOS 26.5%, and LOS >30 45.5%. RAI showed a larger effect for all three outcomes, and major complications in multivariable analyses.ConclusionIncreasing frailty was associated with three key quality metrics that is, eLOS, pLOS, LOS > 30 after neurosurgical procedures. The RAI demonstrated a higher discriminating threshold compared to both mFI‐5 and increasing patient age. Preoperative frailty screening may improve quality metrics through risk mitigation strategies and better preoperative communication with patients and their families.

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Section: Discussionmentioning

confidence: 99%

Section: Variablesmentioning

confidence: 99%

Section: Variablesmentioning

confidence: 99%

Section: Variablesmentioning

confidence: 99%

See 2 more Smart Citations

The risk analysis index demonstrates exceptional discrimination in predicting frailty's impact on neurosurgical length of stay quality metrics

Gagliardi,

Conti,

Courville

et al. 2023

World j. surg.

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The Weight of Frailty in Neurosurgery Patients: Analyzing the Combined Effect of Frailty and Body Mass Index on 30-Day Postoperative Mortality

Branstetter,

Owodunni,

Courville

et al. 2024

World Neurosurgery

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Multiplicative effect of frailty and obesity on postoperative mortality following spine surgery: a deep dive into the frailty, obesity, and Clavien-Dindo dynamic

Owodunni,

Courville,

Peter-Okaka

et al. 2023

Int J Obes

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Background/ObjectivesObesity is a global health challenge that affects > 1/3 adults worldwide. Obesity and frailty pose considerable health risks due to their potential to interact and amplify one another's negative effects.Therefore, we sought to compare the discriminatory thresholds and independent relationship of the risk analysis index (RAI), 5-factor modi ed frailty index (m-FI-5) and greater patient age for the primary endpoint of 30-day postoperative mortality. Subjects/MethodsWe included spine surgery patients ≥ 18 years old, from the American College of Surgeons National Quality Improvement program database from 2012-2020, that were classi ed as obese. We performed receiver operating characteristic curve analysis to compare the discrimination threshold of RAI, mFI-5, and patient age for 30-day postoperative mortality. Risk-adjusted analyses were performed. ResultsOverall, there were 149 163 patients evaluated, and in the ROC analysis for 30-day postoperative mortality, RAI showed superior discrimination C-statistic 0.793 (95% CI: 0.773-0.813), compared to mFI-5 C-statistic 0.671 (95% CI 0.650-0.691), and patient age C-statistic 0.686 (95% CI 0.666-0.707). By subgroups for obesity class I-III, consistent results were observed (C-statistics range: RAI 0.767-0.808; mFI-5 0.642-0.693; patient age 0.665-0.706). In the risk-adjusted analyses, frailty had a dose-dependent relationship with 30-day postoperative mortality, and the RAI had a larger effect size (p<0.001).Additionally, obesity and frailty had a synergistic dose-dependent relationship across obesity class I-III (p<0.001). ConclusionIn this study of 149 163 patients classi ed as obese and undergoing spine procedures in an international prospective surgical database, the RAI demonstrated superior discrimination compared to the mFI-5 and patient age in predicting 30-day postoperative mortality risk. The deleterious effects of frailty and obesity were synergistic as their combined effect predicted worse outcomes.

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Letter: Beyond Risk Assessment: A New Vision for Transdisciplinary Frailty Care Coordination in Neurosurgery

Cited by 3 publications

References 5 publications

The risk analysis index demonstrates exceptional discrimination in predicting frailty's impact on neurosurgical length of stay quality metrics

The risk analysis index demonstrates exceptional discrimination in predicting frailty's impact on neurosurgical length of stay quality metrics

The Weight of Frailty in Neurosurgery Patients: Analyzing the Combined Effect of Frailty and Body Mass Index on 30-Day Postoperative Mortality

Multiplicative effect of frailty and obesity on postoperative mortality following spine surgery: a deep dive into the frailty, obesity, and Clavien-Dindo dynamic

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