Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
World Neurosurg. 2021 Feb;146:e168-e174. doi: 10.1016/j.wneu.2020.10.061. Epub 2020 Oct 17.
The aim of this study is to determine if frailty, defined as modified frailty index (MFI) >2.7, correlated with worse postoperative outcomes in patients with chronic subdural hematomas (CSDHs). We also compare the predictive ability of the MFI with another widely used frailty measure, the Clinical Frailty Scale (CFS).
We conducted a retrospective chart review of elderly patients (≥65 years) who underwent a twist-drill craniostomy for the evacuation of CSDH at Hamilton General Hospital, Canada, between 2016 and 2018. The primary outcome was the modified Rankin Scale scores at discharge. Logistic regression analyses and receiver operating characteristic curves were carried out to further analyze the factors that influenced independence and functional improvement at discharge.
Frail patients were significantly more dependent at discharge (P < 0.0001) and had a lower rate of functional improvement (P = 0.003). When compared with frailty measured by the MFI, frailty as measured by the CFS had a stronger association with functional independence (odds ratio [OR]: 0.081 [0.031, 0.211] vs. OR: 0.256 [0.124, 0.529]) and functional improvement (OR: 0.272 [0.106, 0.693] vs. OR: 0.406 [0.185,0.889]) on logistic regression analyses. Area under the receiver operating characteristic curve analyses showed that the inclusion of frailty into our predictive models improved accuracy.
Elderly patients presenting with CSDH who are frail (MFI >0.27) have significantly worse functional outcomes following twist-drill craniostomies. Therefore assessing frailty in this population is important before managing these patients, and for this purpose the CFS is a superior predictor of postoperative function than the MFI.
本研究旨在确定衰弱（定义为改良衰弱指数（MFI）>2.7）是否与慢性硬膜下血肿（CSDH）患者的术后不良结局相关。我们还比较了 MFI 与另一种广泛使用的衰弱衡量标准临床虚弱量表（CFS）的预测能力。
我们对 2016 年至 2018 年期间在加拿大汉密尔顿综合医院接受扭钻颅骨切开术治疗 CSDH 的老年患者（≥65 岁）进行了回顾性图表审查。主要结局是出院时改良的 Rankin 量表评分。进行逻辑回归分析和受试者工作特征曲线分析，以进一步分析影响出院时独立性和功能改善的因素。
衰弱患者在出院时明显更依赖（P < 0.0001），且功能改善率较低（P = 0.003）。与 MFI 测量的衰弱相比，CFS 测量的衰弱与功能独立性（优势比[OR]：0.081 [0.031，0.211] vs. OR：0.256 [0.124，0.529]）和功能改善（OR：0.272 [0.106，0.693] vs. OR：0.406 [0.185，0.889]）具有更强的关联。受试者工作特征曲线分析的曲线下面积表明，将衰弱纳入我们的预测模型可提高准确性。
患有 CSDH 的虚弱（MFI >0.27）的老年患者在扭钻颅骨切开术后功能明显更差。因此，在管理这些患者之前评估该人群的衰弱情况非常重要，为此，CFS 是术后功能的预测指标优于 MFI。
