Sastry Rahul A, Pertsch Nathan J, Tang Oliver, Shao Belinda, Toms Steven A, Weil Robert J
Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA.
Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA.
J Clin Neurosci. 2020 Nov;81:95-100. doi: 10.1016/j.jocn.2020.09.002. Epub 2020 Oct 2.
Frailty has been associated with increased morbidity and mortality in a variety of surgical disciplines. Few data exist regarding the relationship of frailty with adverse outcomes in craniotomy for brain tumor resection. We assessed the relationship between frailty and the incidence of major post-operative complication, discharge destination other than home, 30-day readmission, and 30-day mortality after elective craniotomy for brain tumor resection. A retrospective cohort study was conducted on 20,333 adult patients undergoing elective craniotomy for tumor resection in the 2012-2018 ACS-NSQIP Participant Use File. Multivariate logistic regression was performed using all covariates deemed eligible through clinical and statistical significance. 6,249 patients (30.7%) were low-frailty and 2,148 patients (10.6%) were medium-to-high frailty. In multivariate logistic regression adjusting for age, gender, BMI, ASA classification, smoking status, dyspnea, significant pre-operative weight loss, chronic steroid use, bleeding disorder, tumor type, and operative time, low frailty was associated with increased adjusted odds ratio of major complication (1.41, 95% CI: 1.23-1.60, p < 0.001), discharge destination other than home (1.32, 95% CI: 1.20-1.46, p < 0.001), 30-day readmission (1.29, 95% CI: 1.15-1.44, p < 0.001), and 30-day mortality (1.87, 95% CI: 1.41-2.47, p < 0.001). Moderate-to-high frailty was also associated with increased adjusted odds of major complication (1.61, 95% CI: 1.35-1.92, p < 0.001), discharge destination other than home (1.80, 95% CI: 1.58-2.05), 30-day readmission (1.39, 95% CI: 1.19-1.62, p < 0.001), and 30-day mortality (2.42, 95% CI: 1.74-3.38, p < 0.001). CONCLUSIONS: Frailty is associated with increased odds of major post-operative complication, discharge to destination other than home, 30-day readmission, and 30-day mortality.
衰弱与多种外科手术学科中发病率和死亡率的增加相关。关于衰弱与脑肿瘤切除开颅手术不良结局之间的关系，现有数据较少。我们评估了衰弱与脑肿瘤切除择期开颅手术后主要术后并发症的发生率、非回家的出院去向、30天再入院率和30天死亡率之间的关系。对2012 - 2018年美国外科医师协会国家外科质量改进计划（ACS - NSQIP）参与者使用文件中20333例接受择期开颅肿瘤切除术的成年患者进行了一项回顾性队列研究。使用通过临床和统计学意义判定为合格的所有协变量进行多因素逻辑回归分析。6249例患者（30.7%）为低衰弱，2148例患者（10.6%）为中度至高度衰弱。在对年龄、性别、体重指数、美国麻醉医师协会（ASA）分级、吸烟状况、呼吸困难、术前显著体重减轻、长期使用类固醇、出血性疾病、肿瘤类型和手术时间进行调整的多因素逻辑回归分析中，低衰弱与主要并发症调整后的优势比增加相关（1.41，95%置信区间：1.23 - 1.60，p < 0.001）、非回家的出院去向（1.32，95%置信区间：1.20 - 1.46，p < 0.001）、30天再入院率（1.29，95%置信区间：1.15 - 1.44，p < 0.001）和30天死亡率（1.87，95%置信区间：1.41 - 2.47，p < 0.001）。中度至高度衰弱也与主要并发症调整后的优势比增加相关（1.61，95%置信区间：1.35 - 1.92，p < 0.001）、非回家的出院去向（1.80，95%置信区间：1.58 - 2.05）、30天再入院率（1.39，95%置信区间：1.19 - 1.62，p < 0.001）和30天死亡率（2.42，95%置信区间：1.74 - 3.38，p < 0.001）。结论：衰弱与主要术后并发症、非回家的出院去向、30天再入院率和30天死亡率的优势比增加相关。
