Frailty predicts worse outcomes after intracranial meningioma surgery irrespective of existing prognostic factors
Frailty predicts worse outcomes after intracranial meningioma surgery irrespective of existing prognostic factors
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DOI：
10.3171/2020.7.focus20324
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发表时间：
2020-10-01
影响因子：
4.1
通讯作者：
Bowers, Christian A.
中科院分区：
文献类型：
--
作者：
Theriault, Brianna C.;Pazniokas, Julia;Bowers, Christian A.
目的在多个外科学科中，虚弱已被认为是不良手术结果的预测因子，但到目前为止，虚弱与颅内脑膜瘤手术之间的关系尚未被研究过。本研究的目的是确定增加的虚弱(使用修正的虚弱指数[MFI]确定)与颅内脑膜瘤切除结果(包括住院时间[LOS]、出院地点、再手术和再住院率)之间的关系。结果脆弱性与住院时间增加(p=0.0218)、再手术率增加(p=0.029)以及出院到更高水平的护理机构：住院康复机构或熟练护理机构(p=0.0002)有关。多变量分析后，脆弱被确定为增加LOS、较差的出院倾向和随后再入院的独立危险因素。结论脆弱是颅内脑膜瘤切除术后较差结局的独立危险因素，包括增加的LOS、再手术和较差的出院倾向。脆弱性可能有助于对术前手术风险进行分层，从而可能提供重要的临床信息，帮助神经外科医生和老年患者权衡切除的风险和好处。
OBJECTIVE Frailty has been recognized as a predictor of adverse surgical outcomes across multiple surgical disciplines, but until now the relationship between frailty and intracranial meningioma surgery has not been studied. The goal of the present study was to determine the relationship between increasing frailty (determined using the modified Frailty Index [mFI]) and intracranial meningioma resection outcomes (including hospital length of stay [LOS], discharge location, and reoperation and readmission rates).METHODS This is a single-center retrospective cohort study of patients who underwent intracranial meningioma resection between August 2012 and May 2018. Seventy-six patients met the inclusion criteria.RESULTS Frailty was associated with increased hospital LOS (p = 0.0218), increased reoperation rate (p = 0.029), and discharge to a higher level of care: an inpatient rehabilitation facility or a skilled nursing facility (p = 0.0002). After multivariable analysis, frailty was determined to be an independent risk factor for increased LOS, worse discharge disposition, and subsequent readmission.CONCLUSIONS Frailty is an independent risk factor for worse outcomes following intracranial meningioma resection, including increased LOS, reoperations, and worse discharge disposition. Frailty may help stratify preoperative surgical risk, and thus may provide important clinical information to help neurosurgeons and elderly patients weigh the risks and benefits of resection.