The association of frailty, age, and ASA classification with postoperative outcomes in minimally invasive pituitary surgery

Martin, Elaine; Goshtasbi, Khodayar; Birkenbeuel, Jack; Abiri, Arash; Lehrich, Brandon M.; Mohyeldin, Ahmed; Hsu, Frank P.K.; Kuan, Edward C.

doi:10.1002/alr.22916

Cited by 4 publications

(6 citation statements)

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“…This correlates with clinical practice in the sense that there are a minority of patients unable to tolerate therapeutic chemotherapy or radiation and have progression of their disease. Assessing and optimizing pretreatment comorbidities and measures of frailty is a growing area of research and these factors have been increasingly recognized to be associated with outcomes, particularly in otolaryngologic and rhinologic disease 27–31 . Male sex was associated with increased side effects to treatment within our cohort, although the underlying etiology of this observation remains unclear.…”

Section: Discussionmentioning

confidence: 91%

“…Assessing and optimizing pretreatment comorbidities and measures of frailty is a growing area of research and these factors have been increasingly recognized to be associated with outcomes, particularly in otolaryngologic and rhinologic disease. [27][28][29][30][31] Male sex was associated with increased side effects to treatment within our cohort, although the underlying etiology of this observation remains unclear. Finally, the only risk factor associated with recurrence was younger age on multivariate analysis, presumably due to increased years of life from the time of diagnosis compared with earlier cohorts.…”

Section: Discussionmentioning

confidence: 99%

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Primary sinonasal lymphoma: A multi‐institutional experience of clinical presentation, treatment, and outcomes

Eide

Kshirsagar

Birkenbeuel

et al. 2022

Int Forum Allergy Rhinol

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Background Sinonasal lymphoma (SL) is a heterogeneous, underrecognized neoplastic disorder with limited outcomes data. We sought to better define outcomes by subtype and treatment at 2 referral centers over the past 2 decades. Methods Demographics, clinicopathologic data, and treatment outcomes for patients treated for SL were queried from January 1, 2000 to December 31, 2021 at 2 tertiary academic medical centers. Results Eighty‐four patients were included, with an average age at diagnosis of 63.4 ± 15 years. There were 34 females (40.5%). The majority of patients had an Eastern Cooperative Oncology Group (ECOG) score of <2 (76.2%) and the most common presenting symptom was facial swelling/pain (26.2%). The most common primary site was the nasal cavity (36.9%). Diffuse large B‐cell lymphoma was the most common subtype (46.4%), followed by extranodal NK/T‐cell lymphoma (17.9%). Chemotherapy was the most common treatment strategy (n = 59, 70.2%), followed by radiation therapy (n = 35, 41.7%) and immunotherapy (n = 24, 28.6%). Disease‐specific survival rates at 1, 5, and 10 years were 85.7%, 73.6%, and 58.6%, respectively. Eighteen patients (21.4%) developed recurrence. On multivariate analysis, higher ECOG score (p < 0.0001) and history of head and neck radiation (p = 0.048) were associated with worse survival. Younger age was associated with greater risk of recurrence (p = 0.022) and male sex was associated with more treatment side effects (p = 0.012). Conclusion This is the largest multi‐institutional analysis of SL characteristics and outcomes. Our work suggests that, although disease control in the first 5 years is reasonable, 10‐year outcomes remain challenging. Further studies are needed to investigate new treatment paradigms and risk stratification.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Primary sinonasal lymphoma: A multi‐institutional experience of clinical presentation, treatment, and outcomes

Eide

Kshirsagar

Birkenbeuel

et al. 2022

Int Forum Allergy Rhinol

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“…Khallafallah et al found similar findings in an institutional study using the mFI‐5 tool, suggesting its use in preoperative risk stratification 32 . Martin et al reviewed 1926 patients undergoing endoscopic or microscopic pituitary resection in the American College of Surgeons National Surgical Quality Improvement Program and found an mFI‐5 score of 2‐5 associated with an increased length of hospitalization and a greater risk of medical complications 11 …”

Section: Discussionmentioning

confidence: 84%

“…Frailty as a metric has also been examined in skull base surgery 7 . and otolaryngology, 8‐10 and also explored in the context of endoscopic skull base surgery, though prior work has largely focused on pituitary surgery 11,12 . Frailty metrics have also recently been used as screening tools to help predict adverse postoperative outcomes and are increasingly recognized as important in quality improvement and outcomes assessment 13 …”

mentioning

confidence: 99%

“…7 and otolaryngology, [8][9][10] and also explored in the context of endoscopic skull base surgery, though prior work has largely focused on pituitary surgery. 11,12 Frailty metrics have also recently been used as screening tools to help predict adverse postoperative outcomes and are increasingly recognized as important in quality improvement and outcomes assessment. 13 Several tools have been developed to estimate frailty including the Charlson comorbidity index (CCI), 5-item modified frailty index (mFI-5), and the American Society of Anesthesiologists (ASA) classification for physical status.…”

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confidence: 99%

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Impact of Frailty on Postoperative Outcomes in Extended Endonasal Skull Base Surgery for Suprasellar Pathologies

Kshirsagar,

Eide,

Qatanani

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveFrailty metrics estimate a patient's ability to tolerate physiologic stress and there are limited frailty data in patients undergoing expanded endonasal approaches (EEA) for suprasellar pathologies. Elevated frailty metrics have been associated with increased perioperative complications in patients undergoing craniotomies. We sought to examine this potential relationship in EEA.Study DesignRetrospective cohort study.SettingTwo tertiary academic skull base centers.MethodsCases of patients undergoing EEA for suprasellar pathologies were reviewed. Demographic, treatment, survival, and postoperative outcomes data were recorded. Frailty was calculated using validated indexes, including the American Society of Anesthesiologists (ASA) classification, the modified 5‐item frailty index (mFI‐5), and the Charlson comorbidity index (CCI). Primary outcomes included 30‐day medical and surgical complications.ResultsA total of 88 patients were included, with 59 (67%) female patients and a mean age of 54 ± 15 years. The most common pathologies included 53 meningiomas (60.2%) and 21 craniopharyngiomas (23.9%). Most patients were ASA class 3 (54.5%) with mean mFI‐5 0.82 ± 1.01 and CCI 4.18 ± 2.42. There was no association between increased frailty and 30‐day medical or surgical outcomes (including postoperative cerebrospinal fluid leak), prolonged length of hospital stay, or mortality (all P > .05). Higher mFI‐5 was associated with an increased risk for 30‐day readmission (odds ratio: 2.35, 95% confidence Interval: 1.10‐5.64, P = .04).ConclusionDespite the patient population being notably frail, we only identified an increased risk for 30‐day readmission and observed no links with deteriorating surgical, medical, or mortality outcomes. This implies that conventional frailty metrics may not effectively align with EEA outcomes.

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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

Aghajanian

Shafiee

Ahmadi

et al. 2023

Journal of Clinical Neuroscience

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The association of frailty, age, and ASA classification with postoperative outcomes in minimally invasive pituitary surgery

Cited by 4 publications

References 10 publications

Primary sinonasal lymphoma: A multi‐institutional experience of clinical presentation, treatment, and outcomes

Primary sinonasal lymphoma: A multi‐institutional experience of clinical presentation, treatment, and outcomes

Impact of Frailty on Postoperative Outcomes in Extended Endonasal Skull Base Surgery for Suprasellar Pathologies

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

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