Nasrollahi Tasha S, Shahrestani Shane, Borrelli Michela, Raskin Jonathan, Hopp Martin L, Wu Arthur W, Miller Mia E, Wong Yu-Tung
Cedars-Sinai Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
J Clin Neurosci. 2022 May;99:82-88. doi: 10.1016/j.jocn.2022.03.013. Epub 2022 Mar 9.
The incidence of acoustic neuromas in the United States is 1.09 per 100,000 with 23,739 newly diagnosed cases in the years 2004 to 2010. Because the recent literature has supported that frailty can serve as a more accurate predictor of patient outcomes when evaluated with age, and is an important variable to consider in the course of patient treatment. The objective of this study was to compare the outcomes of frail patients who had undergone surgery for acoustic neuroma with their non-frail counterparts.The authors conducted a retrospective cohort study of geriatric patients receiving cranial neurosurgery for acoustic neuroma between 2016 and 2017 by using the Nationwide Readmission Database. A total of 396 frail patients and 402 non-frail patients were identified through the database of undergoing surgery for acoustic neuroma. Frail patients had statistically higher rates of readmission (p < 0.01), post-operative infection (p < 0.01), facial paralysis (p < 0.01), urinary tract infection (p < 0.01), hydrocephalus (p < 0.01), and dysphagia (p < 0.01). These post-op morbidities likely led to the increased length of stay (p < 0.01), non-routine discharge (p < 0.01), and all payer cost seen in frail patients (p < 0.01). However, no significant difference was found between frail and non-frail patients with regards to CSF leak, post hemorrhagic anemia, myocardial infarction, and mortality. Patient frailty status is a significant predictor of poor outcomes in the postoperative sequelae of acoustic neuroma surgery. Further, models including patient frailty plus age outperformed those using age alone for prediction of several postoperative complications.
在美国，听神经瘤的发病率为每10万人中有1.09例，在2004年至2010年期间有23739例新诊断病例。因为最近的文献支持，在结合年龄评估时，衰弱可以作为患者预后更准确的预测指标，并且是患者治疗过程中需要考虑的一个重要变量。本研究的目的是比较接受听神经瘤手术的衰弱患者与非衰弱患者的预后。作者利用全国再入院数据库，对2016年至2017年期间接受听神经瘤开颅手术的老年患者进行了一项回顾性队列研究。通过听神经瘤手术数据库共识别出396例衰弱患者和402例非衰弱患者。衰弱患者的再入院率（p<0.01）、术后感染率（p<0.01）、面瘫率（p<0.01）、尿路感染率（p<0.01）、脑积水率（p<0.01）和吞咽困难率（p<0.01）在统计学上更高。这些术后并发症可能导致衰弱患者住院时间延长（p<0.01）、非常规出院（p<0.01）以及所有支付方成本增加（p<0.01）。然而，在脑脊液漏、出血后贫血、心肌梗死和死亡率方面，衰弱患者与非衰弱患者之间未发现显著差异。患者的衰弱状态是听神经瘤手术后不良预后的重要预测指标。此外，包括患者衰弱状态加年龄的模型在预测几种术后并发症方面优于仅使用年龄的模型。
