Cole Kyril L, Babajanian Eric, Anderson Ryan, Gordon Steve, Patel Neil, Dicpinigaitis Alis J, Kazim Syed Faraz, Bowers Christian A, Gurgel Richard K
School of Medicine, University of Utah, Salt Lake City, Utah, USA.
Division of Otolaryngology, University of Utah, Salt Lake City, Utah, USA.
Otol Neurotol. 2022 Dec 1;43(10):1170-1175. doi: 10.1097/MAO.0000000000003717. Epub 2022 Oct 3.
To conduct a national registry-based evaluation of the independent associations of chronological age and frailty, as measured by 5- and 11-factor modified frailty index (mFI-5, mFI-11) score, on postoperative outcomes of participants undergoing cochlear implantation (CI).
Cross-sectional analysis.
Multicenter national database.
Adults 18 years or older who underwent CI during 2001 to 2018.
Any postoperative complications (determined as the presence of major, minor, or implant-specific), extended hospital length of stay (eLOS) (≥75th percentile of study population), and nonhome discharge destination.
There were 5,130 participants included with a median age of 60 years (interquartile range, 44-73 y) and slight female predominance (53.5%). Under mFI-5 scoring, there were 2,979 (58.1%) robust (mFI-5 = 0), 1710 (33.3%) prefrail (mFI-5 = 1), 362 (7.1%) frail (mFI-5 = 2), and 78 (1.5%) severely frail (mFI-5 ≥ 3) participants. Three hundred twenty-eight (6.49%) participants experienced a postoperative complication, with 320 (6.2%) discharged to a nonhome destination. Multivariate analysis showed no statistically significant correlation between increasing participant age or frailty status and postoperative complications; however, increasing baseline frailty tier showed an independent association with risk of eLOS (severely frail: odds ratio, 4..83; 95% confidence interval, 3.00-7.75; p < 0.001) and nonhome discharge (severely frail: odds ratio, 6.51; 95% confidence interval, 3.81-11.11; p < 0.001). The mFI-11 showed very similar trends.
Among those evaluated, this study demonstrates that CI is a low-risk procedure in participants of all ages. Increasing frailty does not predispose to postoperative complications. However, frail patients are at additional risk for an eLOS and nonhome discharge. Short follow-up time, hospital-coding errors, and selection bias of more robust patients may limit the true results of this study.
通过基于全国登记系统，评估按5因素和11因素改良虚弱指数（mFI-5、mFI-11）评分衡量的实际年龄和虚弱与人工耳蜗植入（CI）参与者术后结局的独立关联。
横断面分析。
多中心全国数据库。
2001年至2018年期间接受CI的18岁及以上成年人。
任何术后并发症（确定为存在重大、轻微或植入物特异性并发症）、延长住院时间（eLOS）（≥研究人群第75百分位数）和非家庭出院目的地。
共纳入5130名参与者，中位年龄为60岁（四分位间距，44 - 73岁），女性略占优势（53.5%）。根据mFI-5评分，有2979名（58.1%）健康参与者（mFI-5 = 0）、1710名（33.3%）pre-frail参与者（mFI-5 = 1）、362名（7.1%）虚弱参与者（mFI-5 = 2）和78名（1.5%）严重虚弱参与者（mFI-5≥3）。328名（6.49%）参与者发生了术后并发症，320名（6.2%）出院至非家庭目的地。多因素分析显示，参与者年龄增加或虚弱状态与术后并发症之间无统计学显著相关性；然而，基线虚弱等级增加与eLOS风险（严重虚弱：比值比，4.83；95%置信区间，3.00 - 7.75；p < 0.001）和非家庭出院（严重虚弱：比值比，6.51；95%置信区间，3.81 - 11.11；p < 0.001）独立相关。mFI-11显示出非常相似的趋势。
在接受评估的人群中，本研究表明CI对所有年龄段的参与者来说都是低风险手术。虚弱程度增加并不会导致术后并发症。然而，虚弱患者有延长住院时间和非家庭出院的额外风险。随访时间短、医院编码错误以及选择更健康患者的选择偏倚可能会限制本研究的真实结果。
