Effects of frailty on postoperative clinical outcomes of aneurysmal subarachnoid hemorrhage: results from the National Inpatient Sample database

Yubin Guo; Hui Wu; Wenhua Sun; Xiang Hu; Jiong Dai

doi:10.1186/s12877-022-03141-0

Effects of frailty on postoperative clinical outcomes of aneurysmal subarachnoid hemorrhage: results from the National Inpatient Sample database

BMC Geriatr. 2022 May 28;22(1):460. doi: 10.1186/s12877-022-03141-0.

Authors

Yubin Guo^{1

2}, Hui Wu^{1

2}, Wenhua Sun^{1

2}, Xiang Hu^{1

2}, Jiong Dai^{3

4}

Affiliations

¹ Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, No.1630 Dongfang Road, Shanghai, 200127, China.
² Cerebrovascular Disease Center, Renji Hospital, Shanghai Jiaotong University School of Medicine, No.2000 Jiangyue Road, Shanghai, 201112, China.
³ Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, No.1630 Dongfang Road, Shanghai, 200127, China. jiongdai94@sbmedu.cn.
⁴ Cerebrovascular Disease Center, Renji Hospital, Shanghai Jiaotong University School of Medicine, No.2000 Jiangyue Road, Shanghai, 201112, China. jiongdai94@sbmedu.cn.

Abstract

Background: This study aimed to investigate the potential effect of preoperative frailty on postoperative clinical outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH).

Methods: Data of patients aged 18 years and older who were diagnosed with subarachnoid hemorrhage or intracerebral hemorrhage, underwent aneurysm repair surgical intervention from 2005 to 2014. A retrospective database analysis was performed based on U.S. National Inpatient Sample (NIS) from 2005 to 2014. Frailty was determined using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses indicator. Patients were stratified into frail and non-frail groups and the study endpoints were incidence of postoperative complications and related adverse clinical outcomes.

Results: Among 20,527 included aSAH patients, 2303 (11.2%) were frail and 18,224 (88.8%) were non-frail. Significant differences were found between frailty and non-frailty groups in the four clinical outcomes (all p < 0.05). Multivariate analysis showed that frailty was associated with significant higher risks of discharge to institutional care (aOR: 2.50, 95%CI: 2.10-2.97), tracheostomy or gastrostomy tube replacement (aOR: 4.41, 95%CI: 3.81-5.10) and postoperative complications (aOR: 3.29, 95%CI: 2.55-4.25) but a lower risk of death in hospital (aOR: 0.40, 95%CI: 0.33-0.49) as compared with non-frailty. Stratified analysis showed the impact of frailty on some of the outcomes were greater among patients younger than 65 years than their older counterparts.

Conclusions: Frailty is significantly correlated with the increased risk of discharge to institutional care, tracheostomy or gastrostomy tube placement, and postoperative complications but with the reduced risk of in-hospital mortality outcomes after aneurysm repair. Frailty seems to have greater impact among younger adults than older ones. Baseline frailty evaluation could be applied to risk stratification for aSAH patients who were undergoing surgery.

Keywords: Aneurysmal subarachnoid hemorrhage (aSAH); Frailty; National inpatient sample (NIS); Postoperative outcomes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Frailty* / complications
Frailty* / diagnosis
Frailty* / epidemiology
Humans
Inpatients
Postoperative Complications / epidemiology
Retrospective Studies
Subarachnoid Hemorrhage* / diagnosis
Subarachnoid Hemorrhage* / epidemiology
Subarachnoid Hemorrhage* / surgery