Anterior Skull Base Outcomes and Complications: A Propensity Score–Matched Evaluation of Age and Frailty as Measured by mFI-5 from the ACS-NSQIP Database

IF 0.3 Q4 SURGERY
S. Bauer, Matthew C. Findlay, Majid Khan, H. Alexander, B. Lucke-Wold, Forrest Hamrick, Joshua C. Hunsaker, W. Couldwell, M. Karsy
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引用次数: 0

Abstract

Abstract Background  Frailty is increasingly recognized as a predictor of surgical outcomes; however, its utility in anterior cranial fossa (ACF) surgery remains unclear. We analyzed whether age and frailty are independent predictors of outcomes after ACF surgery using a retrospective cohort study. Methods  The American College of Surgeons National Surgical Quality Improvement Program database was queried, by Current Procedural Terminology codes, for ACF procedures in 2005 to 2020. Cases included open approaches, endoscopic approaches, and all tumor types except for pituitary adenoma. A propensity score–matched data set was analyzed via multiple logistic regression. Results  Unmatched multivariate analysis of ACF cases demonstrated that severe frailty (modified 5-item frailty index [mFI-5] ≥ 3) was independently associated with having any (odds ratio [OR] = 3.67) and minor (OR = 5.00) complications (both p  < 0.001). Analysis of individual mFI-5 components demonstrated poor functional status was significantly associated with any (OR = 3.39), major (OR = 3.59), and minor (OR = 3.14) complications (all p  < 0.001). After propensity score matching, only age was modestly impactful on minor complications (OR = 1.02) and extended length of stay (eLOS) (OR = 1.02) ( p  < 0.001). Frailty did not maintain its predictive ability after matching. Nonindependent functional status, as a subcomponent of mFI maintained significant predictive ability for any (OR = 4.94), major (OR = 4.68), and minor (OR = 4.80) complications and eLOS (OR = 2.92) (all p  < 0.001). Conclusion  After propensity score matching, age demonstrated a greater ability to predict postoperative complications in ACF surgery than frailty. Rather than age or frailty, functional status served as a better outcome predictor and potential guide for patient counseling. Further validation of these findings in multicenter or disease-specific studies is warranted as well as aims to preoperatively improve functional status in ACF surgery.
前颅底预后和并发症:ACS-NSQIP数据库mFI-5测量的年龄和虚弱倾向评分匹配评估
背景虚弱越来越被认为是手术结果的一个预测因素;然而,其在前颅窝(ACF)手术中的应用尚不清楚。我们通过回顾性队列研究分析了年龄和虚弱是否是ACF手术后预后的独立预测因素。方法采用现行程序术语代码查询美国外科学会国家外科质量改进计划数据库中2005年至2020年的ACF手术。病例包括开放入路、内镜入路和除垂体腺瘤外的所有肿瘤类型。通过多元逻辑回归分析倾向评分匹配的数据集。结果ACF病例的非匹配多变量分析显示,严重虚弱(改良5项虚弱指数[mFI-5]≥3)与任何并发症(优势比[OR] = 3.67)和轻微并发症(OR = 5.00)独立相关(均p < 0.001)。单个mFI-5组件的分析显示,功能状态不良与任何(OR = 3.39)、主要(OR = 3.59)和次要(OR = 3.14)并发症显著相关(均p < 0.001)。倾向评分匹配后,只有年龄对轻微并发症(OR = 1.02)和延长住院时间(eLOS) (OR = 1.02)有轻微影响(p < 0.001)。匹配后,脆弱性不保持其预测能力。非独立功能状态作为mFI的一个子组成部分,对任何(OR = 4.94)、主要(OR = 4.68)和次要(OR = 4.80)并发症和eLOS (OR = 2.92)(均p < 0.001)保持显著的预测能力。结论倾向评分匹配后,年龄比虚弱更能预测ACF术后并发症。而不是年龄或虚弱,功能状态是一个更好的预测结果和潜在的指导病人咨询。在多中心或疾病特异性研究中进一步验证这些发现是必要的,目的是术前改善ACF手术的功能状态。
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来源期刊
CiteScore
0.40
自引率
0.00%
发文量
52
审稿时长
12 weeks
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