The Impact of Frailty on Traumatic Brain Injury Outcomes: An Analysis of 691 821 Nationwide Cases.
Neurosurgery
; 91(5): 808-820, 2022 11 01.
Article
en En
| MEDLINE
| ID: mdl-36069524
ABSTRACT
BACKGROUND:
Frailty, a decline in physiological reserve, prognosticates poorer outcomes for several neurosurgical conditions. However, the impact of frailty on traumatic brain injury outcomes is not well characterized.OBJECTIVE:
To analyze the association between frailty and traumatic intracranial hemorrhage (tICH) outcomes in a nationwide cohort.METHODS:
We identified all adult admissions for tICH in the National Trauma Data Bank from 2007 to 2017. Frailty was quantified using the validated modified 5-item Frailty Index (mFI-5) metric (range = 0-5), with mFI-5 ≥2 denoting frailty. Analyzed outcomes included in-hospital mortality, favorable discharge disposition, complications, ventilator days, and intensive care unit (ICU) and total length of stay (LOS). Multivariable regression assessed the association between mFI-5 and outcomes, adjusting for patient demographics, hospital characteristics, injury severity, and neurosurgical intervention.RESULTS:
A total of 691 821 tICH admissions were analyzed. The average age was 57.6 years. 18.0% of patients were frail (mFI-5 ≥ 2). Between 2007 and 2017, the prevalence of frailty grew from 7.9% to 21.7%. Frailty was associated with increased odds of mortality (odds ratio [OR] = 1.36, P < .001) and decreased odds of favorable discharge disposition (OR = 0.72, P < .001). Frail patients exhibited an elevated rate of complications (OR = 1.06, P < .001), including unplanned return to the ICU (OR = 1.55, P < .001) and operating room (OR = 1.17, P = .003). Finally, frail patients experienced increased ventilator days (+12%, P < .001), ICU LOS (+11%, P < .001), and total LOS (+13%, P < .001). All associations with death and disposition remained significant after stratification for age, trauma severity, and neurosurgical intervention.CONCLUSION:
For patients with tICH, frailty predicted higher mortality and morbidity, independent of age or injury severity.
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Lesiones Traumáticas del Encéfalo
/
Fragilidad
Tipo de estudio:
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
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Humans
/
Middle aged
Idioma:
En
Revista:
Neurosurgery
Año:
2022
Tipo del documento:
Article
País de afiliación:
Estados Unidos