Introduction: Frailty has been associated with worse outcomes among patients undergoing major surgery. The involvement of frailty among patients undergoing craniotomy for resection of malignant gliomas has not been examined.
Methods: Using data from the Nationwide Inpatient Sample 2001-2014, patients undergoing craniotomy for malignant glioma resection were identified. Standard descriptive analysis and propensity-matched multivariate regression evaluated outcomes.
Results: Among 229,258 cases identified, frailty was present in 4.2%. The mean age for frail versus non-frail patients was 50.4±SD21.1 vs 48.7±SD23.2 years (p<0.001); there were no differences in gender distribution between frail and non-frail groups (p=0.56). Frail patients had higher levels of Charlson comorbidity, and higher rates of non-elective surgery (all p<0.001).
Propensity-matched analysis revealed frail patients significantly more likely for surgical complications notably hemorrhagic complications (OR=1.29; 95%CI=1.08-1.54; P=0.01) [including intracerebral hemorrhage (OR=1.33; 95%CI=0.06-1.66; P=0.01); iatrogenic cerebrovascular injury (OR=1.37; 95%CI=1.03-1.82; P=0.03)], toxic encephalopathy (OR=3.89; 95%CI=1.81-8.35; P<0.001), and altered mental-status (OR=2.45; 95%CI=1.75-3.45; P<0.001).
Frail patients were also more likely for medical complications including venous-thromboembolism (OR=1.85; 95%CI=1.24-2.78; P=0.02), pulmonary insufficiency (OR=2.18; 95%CI=1.85-2.57; P<0.001), ventilator-pneumonia (OR=3.01; 95%CI=1.65-5.46; P<0.001), acute renal-failure (OR=1.56; 95%CI=1.11-2.18; P=0.01).
Frail patients were more likely to require prolonged mechanical ventilation exceeding 96 hours (P<0.001). Overall mortality was 1.66%; the odds for mortality [OR=1.44; 95%CI=1.06-1.95; P=0.019], and non-routine discharges [OR=2.45; 95%CI=2.22-2.72; P<0.001] were significantly higher among frail patients.
The mean total charges were significantly higher among frail versus non-frail patients [$139,617.2±SD/162,434 vs. $88,424.39±SD/87,338; p<0.001]; likewise total length of hospitalization was prolonged among frail patients [13.67days (SD16.80) vs 7.64days (SD8.44); p<0.001].
Conclusions: Frail patients undergoing craniotomy for malignant glioma resection demonstrate poor post-operative outcomes. In particular, their greater risk of hemorrhagic complications and iatrogenic cerebrovascular injury underscores the need for more rigorous preoperative evaluation and optimization, and enhanced intraoperative precautionary measures.
Patient Care: By informing healthcare providers on factors affecting outcome.
By providing tools for risk quantification and assessment
Learning Objectives: To improve awareness on issues pertaining to improvement of outcomes