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Frailty Measured by the Risk Analysis Index Predicts Nonhome Discharge and Mortality After Resection in Refractory Epilepsy: Analysis of 1236 Patients From a Prospective Surgical Registry, 2012 to 2020.
Estes, Emily M; Rumalla, Kavelin; Kazim, Syed Faraz; Kassicieh, Alexander J; Segura, Aaron C; Kogan, Michael; Spader, Heather S; Botros, James A; Schmidt, Meic H; Sheehan, Jason P; McKee, Rohini G; Shin, Hae Won; Bowers, Christian A.
Afiliación
  • Estes EM; Texas Tech University Health Sciences Center School of Medicine, El Paso, Texas, USA.
  • Rumalla K; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
  • Kazim SF; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico, USA.
  • Kassicieh AJ; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
  • Segura AC; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico, USA.
  • Kogan M; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
  • Spader HS; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico, USA.
  • Botros JA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
  • Schmidt MH; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico, USA.
  • Sheehan JP; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
  • McKee RG; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
  • Shin HW; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
  • Bowers CA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
Neurosurgery ; 93(2): 267-273, 2023 08 01.
Article en En | MEDLINE | ID: mdl-36853010
BACKGROUND: Risk stratification of epilepsy surgery patients remains difficult. The Risk Analysis Index (RAI) is a frailty measurement that augments preoperative risk stratification. OBJECTIVE: To evaluate RAI's discriminative threshold for nonhome discharge disposition (NHD) and mortality (or discharge to hospice within 30 days of operation) in epilepsy surgery patients. METHODS: Patients were queried from the American College of Surgeons-National Surgical Quality Improvement Program database (2012-2020) using diagnosis/procedure codes. Linear-by-linear trend tests assessed RAI's relationship with NHD and mortality. Discriminatory accuracy was assessed by C-statistics (95% CI) in receiver operating characteristic curve analysis. RESULTS: Epilepsy resections (N = 1236) were grouped into temporal lobe (60.4%, N = 747) and nontemporal lobe (39.6%, N = 489) procedures. Patients were stratified by RAI tier: 76.5% robust (RAI 0-20), 16.2% normal (RAI 21-30), 6.6% frail (RAI 31-40), and 0.8% severely frail (RAI 41 and above). The NHD rate was 18.0% (N = 222) and positively associated with increasing RAI tier: 12.5% robust, 34.0% normal, 38.3% frail, and 50.0% severely frail ( P < .001). RAI had robust predictive discrimination for NHD in overall cohort (C-statistic 0.71), temporal lobe (C-statistic 0.70), and nontemporal lobe (C-statistic 0.71) cohorts. The mortality rate was 2.7% (N = 33) and significantly associated with RAI frailty: 1.1% robust, 8.0% normal, 6.2% frail, and 20.0% severely frail ( P < .001). RAI had excellent predictive discrimination for mortality in overall cohort (C-statistic 0.78), temporal lobe (C-statistic 0.80), and nontemporal lobe (C-statistic 0.74) cohorts. CONCLUSION: The RAI frailty score predicts mortality and NHD after epilepsy surgery. This is accomplished with a user-friendly calculator: https://nsgyfrailtyoutcomeslab.shinyapps.io/epilepsy/ .
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Epilepsia Refractaria / Fragilidad Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Neurosurgery Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Epilepsia Refractaria / Fragilidad Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Neurosurgery Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos