Do we need a neurosurgical frailty index?

Oluwaseyi Adebola
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Abstract

An increasing number of elderly patients now require neurosurgical intervention, and it is sometimes unclear if the benefits of surgery outweigh the risks, especially considering the confounding factor of numerous comorbidities and often poor functional states. Historically, many patients were denied surgery on the basis of age alone. This paper examines the current selection criteria being used to determine which patients get offered neurosurgical management and attempts to show if these patients have a good outcome. Particular focus is given to the increasing insight into the need to develop a neurosurgical frailty index. Using a prospective cohort study, this study observed 324 consecutive patients (n) over a 3-month period who were ≥65 years of age at the time of referral or admission to the neurosurgical department of the Royal Hallamshire Hospital. It highlights the selection model used to determine if surgical intervention was in the patient’s best interest and explores the reasons why some patients did not need to have surgery or were considered unsuitable for surgery. Strengths and weaknesses of different frailty indices and indicators of functional status currently in use are discussed, and how they differ between the patients who had surgery and those who did not. Sixty-one (18.83%) of n were operated on in the timeframe studied. Compared to patients not operated, they were younger, less frail, and more functionally independent. The 30-day mortality of patients who had surgery was 3.28%, and despite the stringent definition of poor outcomes, 65.57% of patients had good postoperative results overall, suggesting that the present selection model for surgery produces good outcomes. The independent variables that showed the greatest correlation with outcome were emergency surgery, the American Society of Anesthesiology grade, the Glasgow Coma Scale, and modified frailty index-5. It would be ideal to carry out future studies of similar designs with a much larger sample size with the goal of improving existing selection criteria and possibly developing a neurosurgical frailty index.
我们需要神经外科虚弱指数吗?
现在,越来越多的老年患者需要接受神经外科手术治疗,但有时并不清楚手术的益处是否大于风险,尤其是考虑到众多合并症和通常较差的功能状态等混杂因素。历史上,许多患者仅因年龄原因就被拒绝手术。本文探讨了目前用于确定哪些患者可接受神经外科治疗的选择标准,并试图说明这些患者是否能获得良好的治疗效果。本研究采用前瞻性队列研究方法,对皇家哈勒姆郡医院神经外科转诊或入院时年龄≥65 岁的 324 名连续患者(n)进行了为期 3 个月的观察。报告强调了用于确定手术干预是否符合患者最佳利益的选择模型,并探讨了一些患者不需要接受手术或被认为不适合手术的原因。报告还讨论了目前使用的不同虚弱指数和功能状态指标的优缺点,以及它们在接受手术和未接受手术的患者之间有何不同。与未接受手术的患者相比,他们更年轻、更不虚弱、功能更独立。接受手术的患者的 30 天死亡率为 3.28%,尽管对不良预后有严格的定义,但 65.57% 的患者术后总体效果良好,这表明目前的手术选择模式产生了良好的预后。与预后相关性最大的自变量是急诊手术、美国麻醉学会分级、格拉斯哥昏迷量表和改良虚弱指数-5。未来最好能以更大的样本量开展类似设计的研究,目的是改进现有的选择标准,并在可能的情况下制定神经外科虚弱指数。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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