Curry Steven D, Hatch Jonathan L, Surdell Daniel L, Gard Andrew P, Casazza Geoffrey C
Department of Otolaryngology - Head and Neck Surgery University of Nebraska Medical Center Omaha Nebraska USA.
Department of Neurosurgery University of Nebraska Medical Center, 988437 Nebraska Medical Center Omaha Nebraska USA.
Laryngoscope Investig Otolaryngol. 2022 Nov 16;7(6):2043-2049. doi: 10.1002/lio2.946. eCollection 2022 Dec.
The modified 5-item frailty index (mFI-5) is a concise, comorbidity-based risk stratification tool that can predict adverse outcomes after surgery. The goal of this study was to understand the frailty of patients undergoing surgery for temporal encephalocele or cerebrospinal fluid (CSF) leak and the utility of mFI-5 for predicting increased post-operative outcomes.
A retrospective review of adults with temporal encephalocele or CSF leak who underwent middle cranial fossa (MCF) approach craniotomies with or without mastoidectomy from January 2015 through August 2021 at a tertiary care academic medical center was performed. Patients who underwent additional surgeries or extended surgical approaches were excluded. The mFI-5 was calculated for all patients. Demographic and clinical data were obtained from the medical record.
Thirty-six patients underwent 40 MCF approach craniotomies for temporal encephalocele or CSF leak, including three revision cases and one patient with sequential bilateral operations. Mean age was 54.1 ± 10.8 years, and 66.7% were female. In the univariable regression analysis, mFI-5 score, age, and procedure time use were significantly associated with increased hospital length of stay (LOS) but not increased intensive care unit (ICU) LOS. Anesthesia time and lumbar drain were significantly associated with increased hospital LOS and ICU LOS, and they remained significantly associated with increased hospital LOS in the multivariable model.
Frailty is associated with increased hospital LOS stay among patients undergoing MCF approach for CSF leak or encephalocele. Reducing anesthesia time and avoiding lumbar drain use are potentially modifiable risk factors that can reduce the LOS and associated costs.
改良的5项衰弱指数（mFI-5）是一种基于合并症的简明风险分层工具，可预测术后不良结局。本研究的目的是了解接受颞部脑膨出或脑脊液（CSF）漏手术患者的衰弱情况以及mFI-5对预测术后不良结局增加的效用。
对2015年1月至2021年8月在一家三级医疗学术医学中心接受中颅窝（MCF）入路开颅手术（有或无乳突切除术）治疗颞部脑膨出或CSF漏的成年患者进行回顾性研究。排除接受额外手术或扩大手术入路的患者。计算所有患者的mFI-5。从病历中获取人口统计学和临床数据。
36例患者接受了40次MCF入路开颅手术治疗颞部脑膨出或CSF漏，包括3例翻修病例和1例连续双侧手术患者。平均年龄为5４.1±10.8岁，66.7%为女性。在单变量回归分析中，mFI-5评分、年龄和手术时间使用与住院时间（LOS）增加显著相关，但与重症监护病房（ICU）LOS增加无关。麻醉时间和腰大池引流与住院LOS和ICU LOS增加显著相关，在多变量模型中它们与住院LOS增加仍显著相关。
在接受MCF入路治疗CSF漏或脑膨出的患者中，衰弱与住院LOS增加相关。减少麻醉时间和避免使用腰大池引流是潜在的可改变风险因素，可降低LOS和相关费用。
4级。
