Worse Pituitary Adenoma Surgical Outcomes Predicted by Increasing Frailty, Not Age.
World Neurosurg
; 161: e347-e354, 2022 05.
Article
de En
| MEDLINE
| ID: mdl-35134588
ABSTRACT
PURPOSE:
Increasing patient age has been associated with worse outcomes after pituitary adenoma resection in previous studies, but the prognostic value of frailty compared with advancing age on pituitary adenoma resection outcomes has not been clearly evaluated.METHODS:
The National Surgical Quality Improvement Program from 2015 to 2019 was queried for data for patients aged >18 years who underwent pituitary adenoma resection (n = 1454 identified patients). Univariate and multivariate analyses of age and frailty (5-factor modified frailty index [mFI-5]) were performed on 30-day mortality, major complications, extended length of stay (eLOS), discharge destination, and readmission and reoperation. The receiver operating characteristic curve analysis was performed to compare effect of age and mFI-5.RESULTS:
On univariate analysis, increasing frailty was significantly associated with greater risk of unplanned readmission (frail odds ratio [OR], 1.9; 95% confidence interval [CI], 1.2-3.2; severely frail OR, 6.9; 95% CI, 2.4-19.8) and a major complication (frail OR, 3.6; 95% CI, 2.1-6.1). Severe frailty was also associated with nonhome discharge (OR, 10.6; 95% CI, 3.2-35.8) and eLOS (OR, 4.5; 95% CI, 1.5-13.4). Increasing age was not associated with any of these outcome measures. Multivariate analysis also demonstrated similar trends. In receiver operating characteristic curve analysis, the mFI-5 score showed higher discrimination for major complications compared with age (area under the curve 0.624 vs. 0.503; P < 0.001).CONCLUSION:
Increasing frailty, and not advancing age, was an independent predictor for major complications, unplanned readmissions, eLOS, and nonhome discharge after pituitary adenoma resection, suggesting frailty to be superior to age in preoperative risk stratification in this patient population.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Tumeurs de l'hypophyse
/
Adénomes
/
Fragilité
Type d'étude:
Prognostic_studies
/
Risk_factors_studies
Limites:
Humans
Langue:
En
Journal:
World Neurosurg
Sujet du journal:
NEUROCIRURGIA
Année:
2022
Type de document:
Article
Pays d'affiliation:
États-Unis d'Amérique