Introduction: The association of frailty with outcome has been studied in many surgeries with frail patients being more likely to require additional treatment. Here, employing a national database, we retrospectively examined the impact of frailty in predicting additional stereotactic radiosurgery (SRS) treatment after transsphenoidal surgery (TSS) for resection of pituitary pathologies.
Methods: The 2001-2014 Nationwide Inpatient Sample was queried and consecutive patients with pituitary lesions who underwent TSS were identified using ICD-9-CM codes. Patients who also underwent SRS after TSS were also identified using the appropriate procedural codes. The odds-ratios of undergoing SRS after TSS were examined in matched propensity score analysis adjusted for multiple confounders.
Results: In total, 115,317 patients who underwent TSS resection of pituitary lesions were included. The mean age of patients undergoing TSS was 51.98 years (SD=15.91). Frailty was present in 1.73%. Frail patients were more likely to be >/=65 years (38.50% vs. 24.02%, p<0.001), black (p<0.001), possess Medicare/Medicaid insurance (p<0.001), of lower median income groups (p<0.001), and have higher comorbidity (p<0.001).
Overall, 1.08% of patients who underwent TSS also underwent SRS procedures. The mean age of patients undergoing SRS was 54.36 years (SD15.56), mostly treated in urban centered teaching hospitals (86.97%), large bed-size hospitals (80.01%), and located in the South (31.57%) and Midwest (28.22%) regions.
Results of propensity-matched and adjusted multivariate regression revealed an increased likelihood of SRS after TSS among frail patients (OR=2.60 95%CI=1.38-4.89, p<0.001). Patients treated in the Midwest also demonstrated increased odds of SRS (OR=1.61; 95%CI=1.11-2.34, p< 0.001). There was no significant independent association between patient age (p=0.34), or higher comorbidity (p=0.07) and likelihood of SRS.
Conclusions: Frailty in patients undergoing TSS predicts a greater likelihood of additional SRS treatment. These findings warrant further validation in prospective cohorts.
Patient Care: By informing providers and caregivers on risk assessment and stratification among patients undergoing pituitary surgery
Learning Objectives: To inform on poor prognostic factors among patients undergoing transsphenoidal surgery and additional radiosurgery