Worse Pituitary Adenoma Surgical Outcomes Predicted by Increasing Frailty, Not Age

Rachel Thommen; Syed Faraz Kazim; Kyril L Cole; Garth T Olson; Liat Shama; Christina M Lovato; Kristen M Gonzales; Alis J Dicpinigaitis; William T Couldwell; Rohini G Mckee; Chad D Cole; Meic H Schmidt; Christian A Bowers

doi:10.1016/j.wneu.2022.02.002

Worse Pituitary Adenoma Surgical Outcomes Predicted by Increasing Frailty, Not Age

World Neurosurg. 2022 May:161:e347-e354. doi: 10.1016/j.wneu.2022.02.002. Epub 2022 Feb 5.

Authors

Affiliations

¹ School of Medicine, New York Medical College, Valhalla, New York, USA.
² Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA.
³ School of Medicine, University of Utah, Salt Lake City, Utah, USA.
⁴ Department of Surgery/Division of Otolaryngology, University of New Mexico, Albuquerque, New Mexico, USA.
⁵ Department of Medicine/Division of Endocrinology, University of New Mexico, Albuquerque, New Mexico, USA.
⁶ Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
⁷ Department of Surgery, University of New Mexico, Albuquerque, New Mexico, USA.
⁸ Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA. Electronic address: CABowers@salud.unm.edu.

PMID: 35134588
DOI: 10.1016/j.wneu.2022.02.002

Abstract

Purpose: Increasing patient age has been associated with worse outcomes after pituitary adenoma resection in previous studies, but the prognostic value of frailty compared with advancing age on pituitary adenoma resection outcomes has not been clearly evaluated.

Methods: The National Surgical Quality Improvement Program from 2015 to 2019 was queried for data for patients aged >18 years who underwent pituitary adenoma resection (n = 1454 identified patients). Univariate and multivariate analyses of age and frailty (5-factor modified frailty index [mFI-5]) were performed on 30-day mortality, major complications, extended length of stay (eLOS), discharge destination, and readmission and reoperation. The receiver operating characteristic curve analysis was performed to compare effect of age and mFI-5.

Results: On univariate analysis, increasing frailty was significantly associated with greater risk of unplanned readmission (frail: odds ratio [OR], 1.9; 95% confidence interval [CI], 1.2-3.2; severely frail: OR, 6.9; 95% CI, 2.4-19.8) and a major complication (frail: OR, 3.6; 95% CI, 2.1-6.1). Severe frailty was also associated with nonhome discharge (OR, 10.6; 95% CI, 3.2-35.8) and eLOS (OR, 4.5; 95% CI, 1.5-13.4). Increasing age was not associated with any of these outcome measures. Multivariate analysis also demonstrated similar trends. In receiver operating characteristic curve analysis, the mFI-5 score showed higher discrimination for major complications compared with age (area under the curve: 0.624 vs. 0.503; P < 0.001).

Conclusion: Increasing frailty, and not advancing age, was an independent predictor for major complications, unplanned readmissions, eLOS, and nonhome discharge after pituitary adenoma resection, suggesting frailty to be superior to age in preoperative risk stratification in this patient population.

Keywords: Age; Frailty; National Surgical Quality Improvement Program (NSQIP); Neurosurgical outcomes; Pituitary adenoma.

MeSH terms

Adenoma* / surgery
Frailty*
Humans
Patient Readmission
Pituitary Neoplasms* / surgery
Treatment Outcome