Frailty and Outcomes After Craniotomy for Nontraumatic Subdural Hematoma. (16th November 2020)

• Record Type: Journal Article
• Authors: Sastry, Rahul; Pertsch, Nathan J; Tang, Oliver Y; Shao, Belinda; Toms, Steven A; Weil, Robert J
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_425
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Frailty is a measure of decreased physiologic reserve and has been associated with increased morbidity and mortality in a variety of surgical disciplines. No data exist regarding the relationship of frailty with adverse outcomes in craniotomy for chronic subdural evacuation. METHODS: A retrospective cohort study was conducted on a population of 1, 647 adult patients undergoing craniotomy for evacuation of atraumatic subdural hematoma in the 2005–2018 ACS-NSQIP Participant Use File. Frailty was assessed using the modified frailty index (mFI-5). Multivariate logistic regression was performed using all covariates deemed eligible through clinical relevance and statistical significance. RESULTS: 416 patients (25.3%) were categorized as no frailty, 698 patients (42.4%) were categorized as low frailty, 411 patients (25.0%) were categorized as medium frailty, and 122 patients (7.4%) were categorized as high frailty. The overall rates of major complication (25.44%), discharge to destination other than home (49.77%), 30-day readmission (11.65%), and 30-day mortality (12.81%) in this analysis were high and increased progressively with increasing frailty. In multivariate regression analysis controlling for age, gender, race, BMI, ASA classification, smoking status, dyspnea, dialysis dependence, chronic steroid use, bleeding disorder, and operative time, medium frailty (mFI-5 = 2) was associated with increased odds of major complication (aOR 1.64, 95% CI: 1.03-2.63), discharge to destination other than home (aOR 2.04, 95% CI: 1.38-3.02), and 30-day mortality (aOR 2.27, 95% CI: 1.08-4.78). High frailty (mFI-5 > 2) was associated with increased odds of 30-day mortality (aOR 2.85, 95% CI: 1.13-7.14). Although there was a trend towards increased odds of major complication and discharge destination other than home, these associations did not achieve statistical significance. CONCLUSION: Pre-operative frailty, as determined by mFI-5, is associated with increased odds of major post-operative complication, discharge to destination other than home, and 30-day mortality after craniotomy for cSDH. Further analyses will be necessary to assess the effects of frailty in less invasive treatments for cSDH and with respect to longer term functional outcomes.