Risk analysis index-measured frailty as a critical predictor of outcomes in patients with non-normal pressure hydrocephalus undergoing first-time shunt surgery: A nationwide study

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-06-11 DOI:10.1016/j.clineuro.2025.109012

Gilberto Perez Rodriguez Garcia , S. Farzad Maroufi , Fnu Ruchika , Danisha Kumar , Christian Bowers , Sarah T. Menacho

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引用次数: 0

Abstract

Objective

To assess the predictive utility of the Risk Analysis Index (RAI) for in-hospital mortality, discharge disposition, extended length of stay (eLOS), and shunt failure in patients with non-NPH hydrocephalus (including obstructive and communicating subtypes) undergoing first-time shunt placement.

Methods

We performed a retrospective cohort study using Nationwide Inpatient Sample data. Non-NPH patients undergoing first-time shunt placement (ICD-10-CM G91.2) were stratified by RAI score (Normal vs. Frail), a metric previously validated for use with NIS data. Patients were further grouped by payer, race, income quartile, and hydrocephalus subtype. Primary outcomes included extended length of stay, non-home discharge, and in-hospital mortality.

Results

In a cohort of 2525 patients (mean age 43.8 years; 50.5 % female), the majority were White (68.4 %) and privately insured (39.6 %), with 92.0 % treated in large, urban teaching hospitals. Frailty was identified in 21.2 % of the cohort and was strongly associated with eLOS (OR 1.23–2.00), NHD (OR 1.74–2.69), and in-hospital mortality (OR 1.66–14.17). The RAI demonstrated the highest predictive value for mortality (AUC = 0.775) and age for NHD (AUC = 0.733; p < 0.01). Additionally, obstructive hydrocephalus (OR 2.12–3.25) was linked to increased odds of eLOS.

Conclusion

RAI-measured frailty, advanced age, and specific non-NPH subtypes predicted adverse shunt outcomes. These findings support the RAI as a valuable tool for risk stratification and personalized perioperative planning in patients with non-NPH hydrocephalus, particularly in subacute presentations. Its use may help guide shared decision-making and resource preparedness.

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风险分析指数测量的虚弱是首次接受分流手术的非正常压力性脑积水患者预后的关键预测因素：一项全国性研究

目的评估风险分析指数（RAI）对首次接受分流器放置的非nph脑积水（包括梗阻性和沟通性亚型）患者的住院死亡率、出院处置、延长住院时间（eLOS）和分流器失效的预测效用。方法采用全国住院患者样本数据进行回顾性队列研究。接受首次分流术的非nph患者（ICD-10-CM G91.2）通过RAI评分（正常vs虚弱）进行分层，该指标先前已通过NIS数据验证。患者进一步按付款人、种族、收入四分位数和脑积水亚型分组。主要结局包括延长住院时间、非家庭出院和住院死亡率。结果2525例患者(平均年龄43.8岁；50.5% %女性)，大多数是白人（68.4% %）和私人保险（39.6% %），92.0 %在大型城市教学医院就诊。队列中有21.2% %的患者虚弱，并且与eLOS （OR 1.23-2.00）、NHD （OR 1.74-2.69）和住院死亡率（OR 1.66-14.17）密切相关。RAI对NHD的死亡率（AUC = 0.775）和年龄的预测值最高(AUC = 0.733；p & lt; 0.01)。此外，梗阻性脑积水（OR 2.12-3.25）与eLOS的发生率增加有关。结论rai测量的虚弱、高龄和特定的非nph亚型预测了不良的分流结果。这些发现支持RAI作为一种有价值的工具，用于非nph脑积水患者的风险分层和个性化围手术期计划，特别是在亚急性表现。它的使用可能有助于指导共同决策和资源准备。

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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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.