Frailty and Postoperative Outcomes Following Endoscopic Endonasal Skull Base Surgery: A Scoping Review.

Abstract

Background: Increased frailty has been associated with worse outcomes in various surgical specialties. In endoscopic endonasal skull base surgery (EESBS), the relationship between frailty and outcomes has been examined to some degree.

Objective: This scoping review aimed to consolidate the current literature, analyzing relationships between frailty and EESBS postoperative outcomes.

Methods: A scoping review of frailty in EESBS was conducted on PubMed, Cochrane Library, Ovid Medline, Web of Science, Embase, and Google Scholar. Initial search yielded a total of 408 articles, which were reduced using the PRISMA model. Four studies published between 2020 and 2023 fit the inclusion criteria for this review.

Results: A total of 1306 patients were captured with an average age of 54.1 years. All studies discussed modified frailty index-5 (mFI-5). Two studies utilized American Society of Anesthesiologists (ASA) classification, and 3 studies examined Charlson Comorbidity Index (CCI) as additional frailty measures. Higher mFI-5 was significantly associated with prolonged length of stay and readmission. Higher ASA was significantly associated with increased rates of Clavien-Dindo IV complications and permanent postoperative diabetes insipidus. CCI was not associated with any of the postoperative complications studied. Frailty was not strongly associated with worsened surgical complications, endocrine dysfunction, visual outcomes, and quality of life after EESBS.

Conclusion: Frailty may serve as a useful tool in anticipating certain postoperative outcomes following EESBS. However, further research is necessary examining frailty specifically within endoscopic endonasal approaches to the skull base, rather than open or microscopic approaches. In addition, future studies need to be consistent in which frailty indices are used, and how frailty data are analyzed for effective conclusions to be made.