1Keck School of Medicine, University of Southern California, Los Angeles.
2Department of Medical Engineering, California Institute of Technology, Pasadena.
Neurosurg Focus. 2020 Oct;49(4):E15. doi: 10.3171/2020.7.FOCUS20426.
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.
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.
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.
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.
衰弱是一种由于年龄相关衰退而导致的易损性增加的临床状态，已被充分确立为围手术期的风险因素。与非老年患者相比，老年患者衰弱的风险更高，脑癌发病率更高，术后并发症发生率也更高。然而，描述衰弱对老年患者短期和长期并发症影响的文献有限。在这项研究中，作者评估了衰弱对接受颅神经外科治疗原发性中枢神经系统肿瘤的老年患者的影响。
作者通过使用全国再入院数据库，对 2010 年至 2017 年间接受颅神经外科治疗原发性中枢神经系统肿瘤的老年患者进行了回顾性队列研究。在初次入院时对患者的人口统计学数据和衰弱情况进行了查询，并在 30、90 和 180 天的间隔时间内对再入院情况进行了分析。感兴趣的并发症包括感染、贫血、梗死、肾损伤、脑脊液漏、尿路感染和死亡率。实施了最近邻倾向评分匹配，以确定具有相似诊断和手术的非衰弱对照患者。分析采用 Welch 两样本 t 检验进行连续变量分析，采用卡方检验和优势比进行分类变量分析。
在初次入院时，共确定了 6713 例衰弱患者和 6629 例非衰弱患者。在初次入院时，接受颅神经外科手术的衰弱老年患者发生急性出血后贫血的几率更高（OR 1.56，95%CI 1.23-1.98；p = 0.00020）；急性感染（OR 3.16，95%CI 1.70-6.36；p = 0.00022）；急性肾损伤（OR 1.32，95%CI 1.07-1.62；p = 0.0088）；出院前尿路感染（OR 1.97，95%CI 1.71-2.29；p < 0.0001）；术后急性脑梗死（OR 1.57，95%CI 1.17-2.11；p = 0.0026）；死亡率（OR 1.64，95%CI 1.22-2.24；p = 0.0012）高于接受相同手术的非衰弱老年患者。此外，与非衰弱患者相比，衰弱患者在初次入院时的住院时间（p < 0.0001）和全支付者医院费用（p < 0.0001）显著增加。然而，在所有再入院时间点，衰弱患者和非衰弱患者的感染、血栓栓塞、脑脊液漏、硬脑膜撕裂、脑梗死、急性肾损伤和死亡率的发生率均无显著差异。
衰弱可能显著增加接受颅神经外科治疗原发性中枢神经系统肿瘤的老年患者短期急性并发症的风险。长期分析显示，衰弱患者和非衰弱患者的并发症无显著差异。需要进一步研究以了解衰弱对老年患者的影响和时间进程。
