Prevalence and Influence of Frailty on Hospital Outcomes After Surgical Resection of Spinal Meningiomas

Aladine A Elsamadicy; Andrew B Koo; Benjamin C Reeves; Samuel Craft; Sumaiya Sayeed; Josiah J Z Sherman; Margot Sarkozy; Lucas Aurich; Tiana Fernandez; Sheng-Fu L Lo; John H Shin; Daniel M Sciubba; Ehud Mendel

doi:10.1016/j.wneu.2023.02.019

Prevalence and Influence of Frailty on Hospital Outcomes After Surgical Resection of Spinal Meningiomas

World Neurosurg. 2023 May:173:e121-e131. doi: 10.1016/j.wneu.2023.02.019. Epub 2023 Feb 10.

Affiliations

¹ Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA. Electronic address: aladine.elsamadicy@yale.edu.
² Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
³ Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York, USA.
⁴ Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.

PMID: 36773810
DOI: 10.1016/j.wneu.2023.02.019

Abstract

Objective: Frailty has been shown to affect patient outcomes after medical and surgical interventions. The Hospital Frailty Risk Score (HFRS) is a growing metric used to assess patient frailty using International Classification of Diseases, Tenth Revision codes. The goal of this study was to investigate the impact of frailty, assessed by HFRS, on health care resource utilization and outcomes in patients undergoing surgery for spinal meningiomas.

Methods: A retrospective cohort study was performed using the 2016-2019 National Inpatient Sample database. Adult patients with benign or malignant spinal meningiomas, identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes, were stratified by HFRS: low frailty (HFRS <5) and intermediate-high frailty (HFRS ≥5). Patient demographics, hospital characteristics, comorbidities, procedural variables, adverse events, length of stay (LOS), discharge disposition, and cost of admission were assessed. Multivariate regression analysis was used to identify predictors of increased LOS, discharge disposition, and cost.

Results: Of the 3345 patients, 530 (15.8%) had intermediate-high frailty. The intermediate-high cohort was significantly older (P < 0.001). More patients in the intermediate-high cohort had ≥3 comorbidities (P < 0.001). In addition, a greater proportion of patients in the intermediate-high cohort experienced ≥1 perioperative adverse events (P < 0.001). Intermediate-high patients experienced greater mean LOS (P < 0.001) and accrued greater costs (P < 0.001). A greater proportion of intermediate-high patients had nonroutine discharges (P < 0.001). On multivariate analysis, increased HFRS (≥5) was independently associated with extended LOS (adjusted odds ratio [aOR], 3.04; P < 0.001), nonroutine discharge (aOR, 1.98; P = 0.006), and increased costs (aOR, 2.39; P = 0.004).

Conclusions: Frailty may be associated with increased health care resource utilization in patients undergoing surgery for spinal meningiomas.

Keywords: Frailty; Health care resource utilization; Hospital frailty risk score/HFRS; Meningioma; Outcomes; Spine; Tumor.

MeSH terms

Adult
Frailty* / epidemiology
Hospitals
Humans
Length of Stay
Meningeal Neoplasms*
Meningioma* / epidemiology
Meningioma* / surgery
Postoperative Complications / epidemiology
Prevalence
Retrospective Studies
Risk Factors