Worse Pituitary Adenoma Surgical Outcomes Predicted by Increasing Frailty, Not Age

Thommen, Rachel; Kazim, Syed Faraz; Cole, Kyril L.; Olson, Garth T.; Shama, Liat; Lovato, Christina; Gonzales, Kristen; Dicpinigaitis, Alis J.; Couldwell, William T.; McKee, Rohini; Cole, Chad; Schmidt, Meic H.; Bowers, Christian A.

doi:10.1016/j.wneu.2022.02.002

Cited by 19 publications

(13 citation statements)

References 35 publications

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“…Thommen et al and Goshtasbi et al found that greater mFI-5 scores were associated with an increased risk of pneumonia, ventilator use, reintubation, sepsis, septic shock, and cardiac arrest, all of which were found in the present study. 16,32 Although these studies did not find an association between mFI-5 and mortality, Johnson et al found that a greater mFI-11 score was associated with increased mortality in adult tracheostomy patients. 34 The association between the component comorbidities, DM, CHF, COPD, hypertension, and functionally dependent health status, of mFI-5 and postoperative complications is well-established.…”

Section: Discussionmentioning

confidence: 96%

“…Patients were then stratified into groups with either mFI-5 scores of 0, 1, or 2, or greater than or equal to 3, as has previously been done in the literature. 16,19 The medical complications assessed included pneumonia, reintubation, ventilation > 48 hours, renal insufficiency, urinary tract infection, cardiac arrest, cerebrovascular accident, deep vein thrombosis, sepsis, and septic shock. The remaining complications included surgical site infections, unplanned readmissions, reoperations, and mortality.…”

Section: Variable Selectionmentioning

confidence: 99%

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Association Between Modified Frailty Index and Postoperative Outcomes of Tracheostomies

Chinta,

Haleem,

Sibala

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveThe 5‐item modified frailty index (mFI‐5) has been used to stratify patients based on the risk of postoperative complications in several surgical procedures but has not yet been done in tracheostomies. This study investigates the association between the mFI‐5 score and tracheostomy complications.Study DesignRetrospective database review.SettingUnited States hospitals.MethodsThe National Surgical Quality Improvement Program database was queried for tracheostomy patients between 2005 and 2018. The mFI‐5 was calculated for each patient by assigning 1 point for each of the following comorbidities: diabetes mellitus, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functionally dependent health status. Univariate and multivariable analyses were conducted to determine associations between the mFI‐5 score and postoperative complications.ResultsA total of 4438 patients undergoing tracheostomies were queried and stratified into the following groups: mFI = 0 (N = 1741 [39.2%], mFI = 1 (N = 1720 [38.8%]), mFI = 2 (N = 726 [16.4%]), and mFI of 3 or higher (N = 251 [5.7%]). Univariate analysis showed that patients with higher mFI‐5 scores had a greater proportion of smoking, dyspnea, obesity, steroid use, emergency cases, complications, reoperations, and mortality (P < .001). Multivariable analyses found associations between mFI‐5 score and any complication (odds ratio [OR]: 1.49, 95% confidence interval [CI]: 1.03‐2.16, P = .035), mortality (OR: 2.32, 95% CI: 1.15‐4.68, P = .019), and any medical complication (OR: 2.75, 95% CI: 1.88‐4.02, P < .001).ConclusionThis study suggests an association between the mFI‐5 score and postoperative complications in tracheostomies. mFI‐5 score can be used to stratify tracheostomy patients by operative risk.

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Section: Discussionmentioning

confidence: 96%

Section: Variable Selectionmentioning

confidence: 99%

Association Between Modified Frailty Index and Postoperative Outcomes of Tracheostomies

Chinta,

Haleem,

Sibala

et al. 2024

Otolaryngol.--head neck surg.

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“…The NSQIP is a nationally validated, multi-institutional database whose characteristics have been summarized before. [16][17][18][19][20] Our data were extracted from the NSQIP database from the years 2015-2019.…”

Section: Data Sourcementioning

confidence: 99%

Risk Analysis Index Predicts Complications and Discharge Outcomes after Brain Tumor Resection Better than Patient Age and Modified Frailty Index-5

Thommen

Hall

Miskimins

et al. 2022

Preprint

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PurposeTo evaluate the discriminative prognostic utility of the Risk Analysis Index-Administrative (RAI-A) as compared to the modified frailty index-5 (mFI-5) and patient age for postoperative outcomes of brain tumor resection (BTR) patients. MethodsPatients with BTR were queried from the National Surgical Quality Improvement Program (NSIQP) for the years 2015 to 2019. Multivariable logistic regression was performed to evaluate the association between frailty tools and postoperative complications and discharge outcomes.ResultsWe identified 30,951 patients that underwent craniotomy for BTR; the median age of our study sample was 59 (IQR 47-68) years old and 47.8% of patients were male. Overall, increasing RAI-A score, in an overall stepwise fashion, was associated with increased post-operative outcomes including in-hospital mortality, non-routine discharge, major complications, Clavien-Dindo Grade IV complication, and extended length of stay. The RAI-A tiers 41-45 and >45 were ~4 (Odds Ratio [OR]: 4.3, 95% CI: 2.1-8.9) and ~9 (OR: 9.5, 95% CI: 3.9-22.9) more times more likely to have mortality compared to RAI-A 0-20. Multivariable regression analysis (adjusting for age, sex, BMI, non-elective surgery status, race, and ethnicity) demonstrated that RAI-A was an independent predictor of all BTR outcomes.Conclusions and RelevanceIncreasing RAI-A score is a better predictor than the mFI-5 and increasing patient age for in-hospital complications and discharge outcomes in BTR patients. The RAI-A may help providers present better preoperative risk assessment for patients and families weighing the risks and benefits of potential BTR.

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“…There is a growing body of literature utilizing the modified frailty index 5 (mFI-5) to predict postoperative outcomes for patients undergoing various types of surgery using data collected for the American College of Surgeons prospective registry, the National Surgical Quality Improvement Program (NSQIP). [4][5][6] Age can be a useful predictor of postoperative outcomes but has shown to be worse than mFI-5 in some studies. 7 When mFI-5 has been studied specifically in microvascular reconstruction of the head and neck it has been shown to be a significant predictor of risk of longer hospitalization, reoperation, mortality, and unplanned readmission.…”

Section: Introductionmentioning

confidence: 99%

Frailty as a Predictor of Post-Surgical Outcomes in Patients With Cutaneous Malignancies of the Scalp and Neck Requiring Flap Reconstruction

Welch

Kazim

Esce

et al. 2023

Ann Otol Rhinol Laryngol

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Background: Investigate the ability of frailty status to predict post-surgical outcomes in patients with cutaneous malignancies of the scalp and neck undergoing flap reconstruction. Methods: National Surgical Quality Improvement Program database was used to isolate patients with cutaneous malignancies of the scalp and neck who underwent surgical resection between 2015 to 2019. Univariate and multivariate analyses were performed to determine if frailty score correlated with negative post-operative outcomes. Receiver operating characteristic (ROC) curves allowed testing of the discriminative performance of age versus frailty. Results: This study demonstrated an independent correlation between frailty and major complications as well as non-home discharge. In ROC curve analysis, frailty demonstrated superior discrimination compared to age for predicting major complications. Conclusion: Our study demonstrated an association between increasing frailty and major complications as well as the likelihood of a non-home discharge. When compared to age, frailty was also shown to be a better predictor of major complications.

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Worse Pituitary Adenoma Surgical Outcomes Predicted by Increasing Frailty, Not Age

Cited by 19 publications

References 35 publications

Association Between Modified Frailty Index and Postoperative Outcomes of Tracheostomies

Association Between Modified Frailty Index and Postoperative Outcomes of Tracheostomies

Risk Analysis Index Predicts Complications and Discharge Outcomes after Brain Tumor Resection Better than Patient Age and Modified Frailty Index-5

Frailty as a Predictor of Post-Surgical Outcomes in Patients With Cutaneous Malignancies of the Scalp and Neck Requiring Flap Reconstruction

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