Zaki Peter G, Bolger John, Rogowski Brandon, Busch Nisha, Elhamdani Shahed, Jeong Seung, Li Jenna, Leonardo Jody, Williamson Richard, Yu Alexander, Shepard Matthew J
College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, Allegheny Health Network, Neuroscience Institute, Pittsburgh, Pennsylvania, USA.
World Neurosurg. 2023 Nov;179:e328-e341. doi: 10.1016/j.wneu.2023.08.085. Epub 2023 Aug 25.
Increasing frailty is a significant determinant of perioperative morbidity and mortality within neurosurgical literature. This study investigates the predictive value of the modified frailty index 5 (mFI-5) for postoperative morbidity and mortality following surgical drainage of chronic subdural hematoma (cSDH).
A retrospective cohort study was performed on patients who underwent surgical evacuation of a cSDH. The mFI-5 score was calculated for each patient and used to stratify patients: prefrail (mFI-5<2), frail (mFI-5 = 2), and severely frail (mFI-5>2). Multivariate Cox proportional hazards (CPH) regression analysis were used to identify factors associated with our primary outcomes: overall survival and 30-day readmission. Secondary outcomes included nonhome discharge, length of stay, hematoma accumulation, development of new postoperative neurologic deficits, resolution of preoperative neurologic deficits, and a modified Rankin score >2 at discharge.
118 patients with a mean age of 74.4 ± 11.9 years were analyzed. All baseline demographics were similar across the 3 groups. On multivariate analysis, severely frail patients (N = 24, 20.3%) had increased rates of 30-day readmission (hazard ratio [HR] 4.3, CPH regression P value<0.001) and postoperative mortality (HR 3.1, CPH regression P value<0.01) compared to the prefrail cohort. Severely frail patients had increased rates of nonhome disposition (HR 9.6, CPH regression P value< 0.001), development of new postoperative neurologic deficits (HR 2.75, CPH regression P value = 0.03), and hematoma reaccumulation (HR 4.07, CPH regression P value = 0.004). A novel scoring system accounting for patient age and frailty was predictive of 90-day mortality (area under the curve 0.77).
Frailty, measured by the mFI-5, and our novel scoring system hold a predictive value regarding outcomes for patients undergoing surgical drainage of a cSDH.
在神经外科文献中，日益增加的衰弱是围手术期发病率和死亡率的一个重要决定因素。本研究调查改良衰弱指数5（mFI-5）对慢性硬膜下血肿（cSDH）手术引流术后发病率和死亡率的预测价值。
对接受cSDH手术清除的患者进行一项回顾性队列研究。计算每位患者的mFI-5评分，并用于对患者进行分层：虚弱前期（mFI-5<2）、虚弱（mFI-5 = 2）和严重虚弱（mFI-5>2）。采用多变量Cox比例风险（CPH）回归分析来确定与我们的主要结局相关的因素：总生存率和30天再入院率。次要结局包括非家庭出院、住院时间、血肿积聚、新的术后神经功能缺损的发生、术前神经功能缺损的缓解以及出院时改良Rankin评分>2。
分析了118例平均年龄为74.4±11.9岁的患者。三组患者的所有基线人口统计学特征相似。多变量分析显示，与虚弱前期队列相比，严重虚弱患者（n = 24，20.3%）的30天再入院率（风险比[HR] 4.3，CPH回归P值<0.001）和术后死亡率（HR 3.1，CPH回归P值<0.01）更高。严重虚弱患者的非家庭出院率（HR 9.6，CPH回归P值<0.001）、新的术后神经功能缺损的发生率（HR 2.75，CPH回归P值 = 0.03）和血肿再积聚率（HR 4.07，CPH回归P值 = 0.004）更高。一种考虑患者年龄和衰弱情况的新型评分系统可预测90天死亡率（曲线下面积为0.77）。
通过mFI-5测量的衰弱以及我们的新型评分系统对接受cSDH手术引流的患者的结局具有预测价值。
