Roy Joanna M, Prvulovic Stefan T, Warrier Akshay, Mousavi Arash K, Bhalla Shubhang, Sanchez Damian, Jagtiani Pemla, Verma Vinay, Varghese Jonathan Roy, Sanmuganthan Praveen, Delashaw Johnny, Bowers Christian A
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.
Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Flint , Michigan , USA.
Neurosurgery. 2025 Nov 1;97(5):1170-1177. doi: 10.1227/neu.0000000000003472. Epub 2025 Apr 23.
Failure to rescue (FTR) occurs when mortality happens within 30 days after a major postoperative complication. The surgical literature contains varying FTR rates based on various patient characteristics and postoperative complication rates. The impact of frailty on FTR has yet to be described within the context of brain tumor resection (BTR). Our study identified patient characteristics and postoperative complications predictive of FTR in this cohort.
BTR patients were identified from the American College of Surgeons-National Surgical Quality Improvement Program database (2012-2020) based on craniotomy codes. Frailty was measured using the Risk Analysis Index as has been previously described.
There were 31 667 BTR patients and 2443 (7.71%) developed a major complication, and 387 (15.8%) experienced FTR. The median age of the cohort was 60 years (IQR 49-69). On multivariate analysis, transfer status (odds ratio [OR]: 1.36, 95% CI: 1.01-1.81) and nonelective surgery (OR: 1.60, 95% CI: 1.22-2.10) were independent predictors of FTR. Frail and severely frail patients who underwent BTR had 4.03-fold and 7.90-fold higher odds of FTR. Postoperative complications predictive of FTR were cardiac arrest (OR: 12.75, 95% CI: 8.16-19.92), unplanned reintubation (OR: 2.46, 95% CI: 1.89-3.16), and septic shock (OR: 2.02, 95% CI: 1.37-2.98). The final predictive model demonstrated excellent discriminatory accuracy (c-statistic: 0.81, 95% CI: 0.79-0.83).
Preoperative patient characteristics, including frailty, and the occurrence of certain expected postoperative complications, such as cardiac arrest, are predictive of FTR in BTR patients. Knowledge of baseline frailty could guide preoperative interventions to optimize patients before surgery.
未能挽救（FTR）是指在重大术后并发症发生后的30天内出现死亡。外科文献中基于不同的患者特征和术后并发症发生率，报道了不同的FTR发生率。在脑肿瘤切除术（BTR）的背景下，衰弱对FTR的影响尚未得到描述。我们的研究确定了该队列中预测FTR的患者特征和术后并发症。
根据开颅手术编码，从美国外科医师学会-国家外科质量改进计划数据库（2012 - 2020年）中确定BTR患者。如前所述，使用风险分析指数测量衰弱程度。
共有31667例BTR患者，其中2443例（7.71%）发生了重大并发症，387例（15.8%）出现了FTR。该队列的中位年龄为60岁（四分位间距49 - 69岁）。多因素分析显示，转院状态（优势比[OR]：1.36，95%置信区间：1.01 - 1.81）和非择期手术（OR：1.60，95%置信区间：1.22 - 2.10）是FTR的独立预测因素。接受BTR的衰弱和严重衰弱患者发生FTR的几率分别高出4.03倍和7.90倍。预测FTR的术后并发症包括心脏骤停（OR：12.75，95%置信区间：8.16 - 19.92）、计划外再次插管（OR：2.46，95%置信区间：1.89 - 3.16）和感染性休克（OR：2.02，95%置信区间：1.37 - 2.98）。最终的预测模型显示出出色的辨别准确性（c统计量：0.81，95%置信区间：0.79 - 0.83）。
术前患者特征，包括衰弱，以及某些预期的术后并发症，如心脏骤停的发生，可预测BTR患者的FTR。了解基线衰弱情况可指导术前干预，以便在手术前优化患者状况。
