CaltechAUTHORS
  A Caltech Library Service

The role of frailty in geriatric cranial neurosurgery for primary central nervous system neoplasms

Shahrestani, Shane and Lehrich, Brandon M. and Tafreshi, Ali R. and Brown, Nolan J. and Lien, Brian V. and Ransom, Seth and Ransom, Ryan C. and Ballatori, Alexander M. and Ton, Andy and Chen, Xiao T. and Sahyouni, Ronald (2020) The role of frailty in geriatric cranial neurosurgery for primary central nervous system neoplasms. Neurosurgical Focus, 49 (4). Art. No. E15. ISSN 1092-0684. https://resolver.caltech.edu/CaltechAUTHORS:20201014-111854888

[img] PDF (Supplementary Table 1) - Supplemental Material
See Usage Policy.

393Kb

Use this Persistent URL to link to this item: https://resolver.caltech.edu/CaltechAUTHORS:20201014-111854888

Abstract

OBJECTIVE. Frailty is a clinical state of increased vulnerability due to age-associated decline and has been well established as a perioperative risk factor. Geriatric patients have a higher risk of frailty, higher incidence of brain cancer, and increased postoperative complication rates compared to nongeriatric patients. Yet, literature describing the effects of frailty on short- and long-term complications in geriatric patients is limited. In this study, the authors evaluate the effects of frailty in geriatric patients receiving cranial neurosurgery for a primary CNS neoplasm. METHODS. The authors conducted a retrospective cohort study of geriatric patients receiving cranial neurosurgery for a primary CNS neoplasm between 2010 and 2017 by using the Nationwide Readmission Database. Demographics and frailty were queried at primary admission, and readmissions were analyzed at 30-, 90-, and 180-day intervals. Complications of interest included infection, anemia, infarction, kidney injury, CSF leak, urinary tract infection, and mortality. Nearest-neighbor propensity score matching for demographics was implemented to identify nonfrail control patients with similar diagnoses and procedures. The analysis used Welch two-sample t-tests for continuous variables and chi-square test with odds ratios. RESULTS. A total of 6713 frail patients and 6629 nonfrail patients were identified at primary admission. At primary admission, frail geriatric patients undergoing cranial neurosurgery had increased odds of developing acute posthemorrhagic anemia (OR 1.56, 95% CI 1.23–1.98; p = 0.00020); acute infection (OR 3.16, 95% CI 1.70–6.36; p = 0.00022); acute kidney injury (OR 1.32, 95% CI 1.07–1.62; p = 0.0088); urinary tract infection prior to discharge (OR 1.97, 95% CI 1.71–2.29; p < 0.0001); acute postoperative cerebral infarction (OR 1.57, 95% CI 1.17–2.11; p = 0.0026); and mortality (OR 1.64, 95% CI 1.22–2.24; p = 0.0012) compared to nonfrail geriatric patients receiving the same procedure. In addition, frail patients had a significantly increased inpatient length of stay (p < 0.0001) and all-payer hospital cost (p < 0.0001) compared to nonfrail patients at the time of primary admission. However, no significant difference was found between frail and nonfrail patients with regard to rates of infection, thromboembolism, CSF leak, dural tear, cerebral infarction, acute kidney injury, and mortality at all readmission time points. CONCLUSIONS. Frailty may significantly increase the risks of short-term acute complications in geriatric patients receiving cranial neurosurgery for a primary CNS neoplasm. Long-term analysis revealed no significant difference in complications between frail and nonfrail patients. Further research is warranted to understand the effects and timeline of frailty in geriatric patients.


Item Type:Article
Related URLs:
URLURL TypeDescription
https://doi.org/10.3171/2020.7.focus20426DOIArticle
ORCID:
AuthorORCID
Shahrestani, Shane0000-0001-7561-4590
Tafreshi, Ali R.0000-0002-8956-3373
Lien, Brian V.0000-0003-3044-8626
Sahyouni, Ronald0000-0002-2124-0535
Additional Information:© AANS 2020. SUBMITTED May 22, 2020. ACCEPTED July 17, 2020. Author Contributions. Conception and design: Shahrestani, Lehrich, RC Ransom. Acquisition of data: Shahrestani, Chen. Analysis and interpretation of data: Shahrestani, Ballatori. Drafting the article: Sahyouni, Shahrestani, Ballatori, Ton. Critically revising the article: Sahyouni, Lehrich, Tafreshi, Brown, Lien, S Ransom, RC Ransom, Ballatori, Ton, Chen. Reviewed submitted version of manuscript: Sahyouni, Lehrich, Tafreshi, Brown, Lien, S Ransom, RC Ransom, Chen. Statistical analysis: Shahrestani. Administrative/technical/material support: Tafreshi, S Ransom, Ballatori, Ton. Study supervision: Sahyouni, Shahrestani, Lehrich, Tafreshi, Brown, Lien, RC Ransom, Ballatori. The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Subject Keywords:geriatric; cranial; tumor; frailty; surgical outcome; risk factor; neurosurgery
Issue or Number:4
Record Number:CaltechAUTHORS:20201014-111854888
Persistent URL:https://resolver.caltech.edu/CaltechAUTHORS:20201014-111854888
Official Citation:Shahrestani S, Lehrich BM, Tafreshi AR, Brown NJ, Lien BV, Ransom S, Ransom RC, Ballatori AM, Ton A, Chen XT, Sahyouni R. The role of frailty in geriatric cranial neurosurgery for primary central nervous system neoplasms. Neurosurg Focus. 2020 Oct;49(4):E15. doi: 10.3171/2020.7.FOCUS20426. PMID: 33002865.
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:106054
Collection:CaltechAUTHORS
Deposited By: George Porter
Deposited On:14 Oct 2020 19:10
Last Modified:14 Oct 2020 19:10

Repository Staff Only: item control page