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Hospital frailty risk score predicts high-value care outcomes following brain metastasis resection.
Kazemi, Foad; Ahmed, A Karim; Roy, Joanna M; Kuo, Cathleen C; Jimenez, Adrian E; Rincon-Torroella, Jordina; Jackson, Christopher; Bettegowda, Chetan; Weingart, Jon; Mukherjee, Debraj.
Afiliación
  • Kazemi F; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
  • Ahmed AK; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
  • Roy JM; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
  • Kuo CC; Department of Neurosurgery, University at Buffalo, Buffalo, NY, United States.
  • Jimenez AE; Department of Neurosurgery, Columbia University Medical Center, New York City, NY, United States.
  • Rincon-Torroella J; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
  • Jackson C; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
  • Bettegowda C; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
  • Weingart J; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
  • Mukherjee D; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: dmukher1@jhmi.edu.
Clin Neurol Neurosurg ; 245: 108497, 2024 Oct.
Article en En | MEDLINE | ID: mdl-39116796
ABSTRACT

OBJECTIVE:

Brain metastases (BM) are the most common adult intracranial tumors, representing a significant source of morbidity in patients with systemic malignancy. Frailty indices, including 11- and 5-factor modified frailty indices (mFI-11 and mFI-5), American Society of Anesthesiologists (ASA) physical status classification, and Charlson Comorbidity Index (CCI), have recently demonstrated an important role in predicting high-value care outcomes in neurosurgery. This study aims to investigate the efficacy of the newly developed Hospital Frailty Risk Score (HFRS) on postoperative outcomes in BM patients.

METHODS:

Adult patients with BM treated surgically at a single institution were identified (2017-2019). HFRS was calculated using ICD-10 codes, and patients were subsequently separated into low (<5), intermediate (5-15), and high (>15) HFRS cohorts. Multivariate logistic regressions were utilized to identify associations between HFRS and complications, length of stay (LOS), hospital charges, and discharge disposition. Model discrimination was assessed using receiver operating characteristic (ROC) curves.

RESULTS:

A total of 356 patients (mean age 61.81±11.63 years; 50.6 % female) were included. The mean±SD for HFRS, mFI-11, mFI-5, ASA, and CCI were 6.46±5.73, 1.31±1.24, 0.95±0.86, 2.94±0.48, and 8.69±2.07, respectively. On multivariate analysis, higher HFRS was significantly associated with greater complication rate (OR=1.10, p<0.001), extended LOS (OR=1.13, p<0.001), high hospital charges (OR=1.14, p<0.001), and nonroutine discharge disposition (OR=1.12, p<0.001), and comparing the ROC curves of mFI-11, mFI-5, ASA,and CCI, the predictive accuracy of HFRS was the most superior for all four outcomes assessed.

CONCLUSION:

The predictive ability of HFRS on BM resection outcomes may be superior than other frailty indices, offering a new avenue for routine preoperative frailty assessment and for managing postoperative expectations.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Neoplasias Encefálicas / Fragilidad Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Neurol Neurosurg Año: 2024 Tipo del documento: Article Pais de publicación: Países Bajos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Neoplasias Encefálicas / Fragilidad Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Neurol Neurosurg Año: 2024 Tipo del documento: Article Pais de publicación: Países Bajos