Preoperative Frailty Risk in Cranioplasty Patients: Risk Analysis Index Predicts Adverse Outcomes.

Cranioplasty is a common surgical procedure used to repair cranial defects, and it is associated with significant morbidity and mortality. Although frailty is a strong predictor of poor postoperative outcomes across surgical specialties, little is known about frailty's impact on cranioplasty outcomes. This study examined the association between frailty and cranioplasty by comparing the effect of the Risk Analysis Index-Administrative (RAI-A) and the Modified Frailty Index-5 (mFI-5) on cranioplasty outcomes. Methods: The National Surgical Quality Improvement Program was queried for patients undergoing cranioplasty between 2012 and 2020. Receiver operating characteristics and multivariable analyses were used to assess the relationship of postoperative outcomes and the RAI-A, mFI-5, and increasing patient age. Results: There were 2864 included study patients with a median age of 57 years (IQR, 44-67), and a higher proportion of patients were women (57.0%) and White (68.5%). The RAI-A had a more robust predictive ability for 30-day mortality (C-Statistic, 0.741; 95% confidence interval (CI), 0.678-0.804) compared with mFI-5 (C-Statistic, 0.574; 95% CI, 0.489-0.659) and increasing patient age (C-Statistic, 0.671; 95% CI, 0.610-0.732). On multivariable analyses, frailty was independently associated with mortality and other poor postoperative outcomes (P < 0.05). Conclusions: The RAI-A demonstrated superior discrimination than the mFI-5 and increasing patient age in predicting mortality. Additionally, the RAI-A showed independent associations with nonhome discharge and postoperative complications (CDII, CDIIIb, and CDIV). The high rates of operative morbidity (5.0%-36.5%) and mortality (0.4%-3.2%) after cranioplasty highlight the importance of identifying independent risk factors for poor cranioplasty outcomes.

Preoperative Laboratory Values Are Predictive of Adverse Postoperative Outcomes in Patients Older Than 65 Years Undergoing Brain Tumor Resection: A National Surgical Quality Improvement Program Study.

OBJECTIVE: In this study, we used a large national database to assess the effect of preoperative laboratory value (PLV) derangements on postoperative outcomes in patients older than 65 years undergoing brain tumor resection. METHODS: Data was collected for patients >65 years old undergoing brain tumor resection from 2015 to 2019 (N = 10,525). Univariate and multivariate analysis were performed for 11 PLVs and 6 postoperative outcomes. RESULTS: Hypernatremia (odds ratio [OR], 4.707; 95% confidence interval [CI], 1.695-13.071; P < 0.01) and increased creatinine level (OR, 2.556; 95% CI, 1.291-5.060; P < 0.01) were the most significant predictors of 30-day mortality. The most significant predictor of Clavien-Dindo grade IV complications was increased creatinine level (OR, 1.667; 95% CI, 1.064-2.613; P < 0.05), whereas, significant predictors of major complications were hypoalbuminemia (OR, 1.426; 95% CI, 1.132-1.796; P < 0.05) and leukocytosis (OR, 1.347; 95% CI, 1.075-1.688; P < 0.05). Predictors of readmission were anemia (OR, 1.326; 95% CI, 1.047-1.680; P < 0.05) and thrombocytopenia (OR, 1.387; 95% CI, 1.037-1.856; P < 0.05), whereas, hypoalbuminemia (OR, 1.787; 95% CI, 1.280-2.495; P < 0.001) was predictive of reoperation. Increased partial thromboplastin time and hypoalbuminemia were predictors of extended length of stay (OR, 2.283, 95% CI, 1.360-3.834, P < 0.01 and OR, 1.553, 95% CI, 1.553-1.966, P < 0.001, respectively). Hypernatremia (OR, 2.115; 95% CI, 1.181-3.788; P < 0.05) and hypoalbuminemia (OR, 1.472; 95% CI, 1.239-1.748; P < 0.001) were the most significant predictors of NHD. Seven of 11 PLVs were associated with adverse postoperative outcomes. CONCLUSIONS: PLV derangements were significantly associated with adverse postoperative outcomes in patients older than 65 years undergoing brain tumor resection. The most significant predictors of adverse postoperative outcomes were hypoalbuminemia and leukocytosis.

Geographic Trends in the Neurosurgery Match During the COVID-19 Pandemic.

In the present article, the impact of the COVID-19 pandemic on geographical trends in the neurosurgery match in successfully matched applicants was analyzed. A cross-sectional analysis for the years from 2017 to 2021 was performed. Successful applicants' region, state, and medical school were compared with the location of their matched residency program. The number of applicants matching at a residency program within the same region or state as their home medical school or their own medical school was then evaluated. One hundred fifteen neurosurgery residency programs and 1066 successfully matched applicants were included in the analysis. When comparing 2021 with previous years, no significant change in the percentage of applicants matching at their home region (43.1% vs 49.7%, P = .09), home state (25.1% vs 26.3%, P = .69), or home program (19.9% vs 18.7%, P = .70) was found. The COVID-19 pandemic did not significantly affect geographic trends during the neurosurgery match in 2021. This is of note as the COVID-19 pandemic significantly affected the match in other competitive specialties, including plastic surgery, dermatology, and otolaryngology. Despite limited away rotations, it is possible that neurosurgery programs did not change their applicant selection criteria and implemented systems to virtually interact with applicants outside of their local region.

COVID-19 and the Otolaryngology Match: An Increase in Applicants Remaining Close to Home.

INTRODUCTION: Otolaryngology residency remains one of the most competitive surgical subspecialties to apply for with a 63% match rate in 2021. This is a difficult and stressful process for applicants in any given year, and it was even further complicated by restrictions mandated by coronavirus disease 2019 (COVID-19) protections. Analyzing geographical trends in successfully matched applicants provides prospective applicants and programs with helpful information about how previous trends were affected by the pandemic as we look toward future match cycles. METHODS: The medical schools of 1,587 successfully matched applicants from 2017-2021 were identified and compared to the 116 otolaryngology residency programs. Successful applicants' medical school state and region were then compared to the location of their matched residency program state and region. From this, we evaluated the number of applicants matching at the residency program affiliated with their medical school or at a residency program within the same state or region as their home medical school. RESULTS: A significant increase in the percentage of applicants matching at their home program and within their home state (p < 0.001) occurred in 2021 when compared to previous years. Applicants matching within their home region was not found to increase significantly (p = 0.43) in 2021 compared to previously. The regions with the greatest increase in the percentage of applicants matching to their home programs were the Northeast and Midwest (12% increase), while the Midwest had the largest increase in percentage of applicants matching within their home state (15%). CONCLUSION: The COVID-19 pandemic significantly affected the otolaryngology match in 2021 with applicants and programs alike choosing to stay closer to home with their residency match selections. Overall, regional location remains a major determinant of future residency location for otolaryngology applicants, and this did not change significantly during 2021, but applicants matched more frequently at their home medical school program. It is anticipated that the match process will be similar in 2022 given the ongoing pandemic, so the importance of home program and region will likely be emphasized again.