J Neurosurg. 2019 Feb 22;132(2):360-370. doi: 10.3171/2018.8.JNS181875. Print 2020 Feb 1.
Frailty, a state of decreased physiological reserve, has been shown to significantly impact outcomes of surgery. The authors sought to examine the impact of frailty on the short-term outcomes of patients undergoing transsphenoidal pituitary surgery.
Weighted data from the 2000-2014 National (Nationwide) Inpatient Sample were studied. Patients diagnosed with pituitary tumors or disorders who had undergone transsphenoidal pituitary surgery were identified. Frailty was determined using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses indicator. Standard descriptive techniques and matched propensity score analyses were used to explore the odds ratios of postoperative complications, discharge dispositions, and costs.
A total of 115,317 cases were included in the analysis. Frailty was present in 1.48% of cases. The mean age of frail versus non-frail patients was 57.14 ± 16.96 years (mean ± standard deviation) versus 51.91 ± 15.88 years, respectively (p < 0.001). A greater proportion of frail compared to non-frail patients had an age ≥ 65 years (37.08% vs 24.08%, respectively, p < 0.001). Frail patients were more likely to be black or Hispanic (p < 0.001), possess Medicare or Medicaid insurance (p < 0.001), belong to lower-median-income groups (p < 0.001), and have greater comorbidity (p < 0.001). Results of propensity score-matched multivariate analysis revealed that frail patients were more likely to develop fluid and electrolyte disorders (OR 1.61, 95% CI 1.07-2.43, p = 0.02), intracranial vascular complications (OR 2.73, 95% CI 1.01-7.49, p = 0.04), mental status changes (OR 3.60, 95% CI 1.65-7.82, p < 0.001), and medical complications including pulmonary insufficiency (OR 2.01, 95% CI 1.13-4.05, p = 0.02) and acute kidney failure (OR 4.70, 95% CI 1.88-11.74, p = 0.01). The mortality rate was higher among frail patients (1.46% vs 0.37%, p < 0.001). Frail patients also demonstrated a greater likelihood for nonroutine discharges (p < 0.001), higher mean total charges ($109,614.33 [95% CI $92,756.09-$126,472.50] vs $56,370.35 [95% CI $55,595.72-$57,144.98], p < 0.001), and longer hospitalizations (9.27 days [95% CI 7.79-10.75] vs 4.46 days [95% CI 4.39-4.53], p < 0.001).
Frailty in patients undergoing transsphenoidal pituitary surgery is associated with worse postoperative outcomes and higher costs, indicating that state's potential role in routine preoperative risk stratification.
衰弱是一种生理储备减少的状态，已被证明对手术结果有重大影响。作者试图研究衰弱对接受经蝶窦垂体手术患者短期结果的影响。
研究了 2000-2014 年全国（全国范围内）住院患者样本的加权数据。确定了诊断为垂体瘤或疾病并接受经蝶窦垂体手术的患者。使用约翰霍普金斯调整后的临床分组（ACG）衰弱定义诊断指标来确定衰弱。使用标准描述性技术和匹配倾向评分分析来探讨术后并发症、出院处置和费用的优势比。
共纳入 115317 例病例。衰弱的发生率为 1.48%。虚弱与非虚弱患者的平均年龄分别为 57.14±16.96 岁（平均值±标准差）和 51.91±15.88 岁（p<0.001）。与非虚弱患者相比，更多虚弱患者的年龄≥65 岁（分别为 37.08%和 24.08%，p<0.001）。虚弱患者更可能是黑人或西班牙裔（p<0.001），拥有医疗保险或医疗补助（p<0.001），属于中低收入群体（p<0.001），并且合并症更多（p<0.001）。倾向评分匹配的多变量分析结果显示，虚弱患者更有可能发生液体和电解质紊乱（OR 1.61，95%CI 1.07-2.43，p=0.02）、颅内血管并发症（OR 2.73，95%CI 1.01-7.49，p=0.04）、精神状态改变（OR 3.60，95%CI 1.65-7.82，p<0.001）和包括肺功能不全（OR 2.01，95%CI 1.13-4.05，p=0.02）和急性肾功能衰竭（OR 4.70，95%CI 1.88-11.74，p=0.01）在内的医疗并发症。虚弱患者的死亡率更高（1.46%比 0.37%，p<0.001）。虚弱患者也更有可能出现非常规出院（p<0.001）、更高的平均总费用（$109614.33 [95%CI $92756.09-$126472.50] 比 $56370.35 [95%CI $55595.72-$57144.98]，p<0.001）和更长的住院时间（9.27 天[95%CI 7.79-10.75] 比 4.46 天[95%CI 4.39-4.53]，p<0.001）。
接受经蝶窦垂体手术的患者衰弱与术后不良结局和更高的费用相关，表明衰弱状态可能在常规术前风险分层中发挥作用。
