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The risk analysis index demonstrates exceptional discrimination in predicting frailty's impact on neurosurgical length of stay quality metrics.
Gagliardi, Thomas A; Conti, Joseph T; Courville, Jordyn T; Owodunni, Oluwafemi P; Courville, Evan N; Kazim, Syed F; Schmidt, Meic H; Bowers, Christian A.
Afiliación
  • Gagliardi TA; New York Medical College School of Medicine, Valhalla, New York, USA.
  • Conti JT; New York Medical College School of Medicine, Valhalla, New York, USA.
  • Courville JT; Louisiana State University Health and Sciences Center School of Medicine, Shreveport, Louisiana, USA.
  • Owodunni OP; Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
  • Courville EN; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico, USA.
  • Kazim SF; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico, USA.
  • Schmidt MH; Department of Neurosurgical Sciences, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
  • Bowers CA; Department of Neurosurgical Sciences, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
World J Surg ; 48(1): 59-71, 2024 01.
Article en En | MEDLINE | ID: mdl-38686751
ABSTRACT

BACKGROUND:

Quality measures determine reimbursement rates and penalties in value-based payment models. Frailty impacts these quality metrics across surgical specialties. We compared the discriminatory thresholds for the risk analysis index (RAI), modified frailty index-5 (mFI-5) and increasing patient age for the outcomes of extended length of stay (LOS [eLOS]), prolonged LOS within 30 days (pLOS), and protracted LOS (LOS > 30).

METHODS:

Patients ≥18 years old who underwent neurosurgical procedures between 2012 and 2020 were queried from the ACS-NSQIP. We performed receiver operating characteristic analysis, and multivariable analyses to examine discriminatory thresholds and identify independent associations.

RESULTS:

There were 411,605 patients included, with a median age of 59 years (IQR, 48-69), 52.2% male patients, and a white majority 75.2%. For eLOS RAI C-statistic 0.653 (95% CI 0.652-0.655), versus mFI-5 C-statistic 0.552 (95% CI 0.550-0.554) and increasing patient age C-statistic 0.573 (95% CI 0.571-0.575). Similar trends were observed for pLOS- RAI 0.718, mFI-5 0.568, increasing patient age 0.559, and for LOS>30- RAI 0.714, mFI-5 0.548, and increasing patient age 0.506. Patients with major complications had eLOS 10.1%, pLOS 26.5%, and LOS >30 45.5%. RAI showed a larger effect for all three outcomes, and major complications in multivariable analyses.

CONCLUSION:

Increasing frailty was associated with three key quality metrics that is, eLOS, pLOS, LOS > 30 after neurosurgical procedures. The RAI demonstrated a higher discriminating threshold compared to both mFI-5 and increasing patient age. Preoperative frailty screening may improve quality metrics through risk mitigation strategies and better preoperative communication with patients and their families.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Procedimientos Neuroquirúrgicos / Fragilidad / Tiempo de Internación Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: World J Surg Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Procedimientos Neuroquirúrgicos / Fragilidad / Tiempo de Internación Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: World J Surg Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos