OBJECTIVE Frailty is a clinical state of increased vulnerability due to age-associated decline and has been well established as a perioperative risk factor. Geriatric patients have a higher risk of frailty, higher incidence of brain cancer, and increased postoperative complication rates compared to nongeriatric patients. Yet, literature describing the effects of frailty on short- and long-term complications in geriatric patients is limited. In this study, the authors evaluate the effects of frailty in geriatric patients receiving cranial neurosurgery for a primary CNS neoplasm. METHODS The authors conducted a retrospective cohort study of geriatric patients receiving cranial neurosurgery for a primary CNS neoplasm between 2010 and 2017 by using the Nationwide Readmission Database. Demographics and frailty were queried at primary admission, and readmissions were analyzed at 30-, 90-, and 180-day intervals. Complications of interest included infection, anemia, infarction, kidney injury, CSF leak, urinary tract infection, and mortality. Nearest-neighbor propensity score matching for demographics was implemented to identify nonfrail control patients with similar diagnoses and procedures. The analysis used Welch two-sample t-tests for continuous variables and chi-square test with odds ratios. RESULTS A total of 6713 frail patients and 6629 nonfrail patients were identified at primary admission. At primary admission, frail geriatric patients undergoing cranial neurosurgery had increased odds of developing acute posthemorrhagic anemia (OR 1.56, 95% CI 1.23–1.98; p = 0.00020); acute infection (OR 3.16, 95% CI 1.70–6.36; p = 0.00022); acute kidney injury (OR 1.32, 95% CI 1.07–1.62; p = 0.0088); urinary tract infection prior to discharge (OR 1.97, 95% CI 1.71–2.29; p 0.0001); acute postoperative cerebral infarction (OR 1.57, 95% CI 1.17–2.11; p = 0.0026); and mortality (OR 1.64, 95% CI 1.22–2.24; p = 0.0012) compared to nonfrail geriatric patients receiving the same procedure. In addition, frail patients had a significantly increased inpatient length of stay (p 0.0001) and all-payer hospital cost (p 0.0001) compared to nonfrail patients at the time of primary admission. However, no significant difference was found between frail and nonfrail patients with regard to rates of infection, thromboembolism, CSF leak, dural tear, cerebral infarction, acute kidney injury, and mortality at all readmission time points. CONCLUSIONS Frailty may significantly increase the risks of short-term acute complications in geriatric patients receiving cranial neurosurgery for a primary CNS neoplasm. Long-term analysis revealed no significant difference in complications between frail and nonfrail patients. Further research is warranted to understand the effects and timeline of frailty in geriatric patients.
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机译：目标脆弱是由于年龄相关的衰退导致脆弱性增加的临床状态，并且已成为围手术期危险因素。老年患者的患者风险较高，脑癌发病率较高，与不良患者相比增加了术后并发症率。然而，文学描述了脆弱对老年患者短期和长期并发症的影响的文献有限。在本研究中，作者评估了脆弱患者对初级CNS肿瘤接受颅神经外科患者的脆弱患者的影响。方法采用全国阅读数据库在2010年和2017年间接受颅神经外科的老年CNS肿瘤患者进行了对老年CNS肿瘤的叙事患者进行了回顾性队列研究。人口统计学和脆弱在初步入场时被询问，并在30-，90-和180天的间隔分析阅览室。利益的并发症包括感染，贫血，梗死，肾损伤，CSF泄漏，尿路感染和死亡率。实施了用于人口统计学的最近邻近倾向分数，以识别具有相似诊断和程序的非框对照患者。该分析用来对连续变量和Chi-Square试验的韦尔奇两样T检验，具有差异比率。结果共6713名脆弱患者和6629名非框患者在初步入院中均确定。在初步入学时，体力大鼠接受颅神经外科的患者患有急性假畸形贫血（或1.56,95％CI 1.23-1.98; P = 0.00020）的几率增加了几率。急性感染（或3.16,95％CI 1.70-6.36; P = 0.00022）;急性肾损伤（或1.32,95％CI 1.07-1.62; P = 0.0088）;尿路感染放电前（或1.97,95％CI 1.71-2.29; P <0.0001）;急性术后脑梗死（或1.57,95％CI 1.17-2.11; P = 0.0026）;与非饲养的GeriTric患者接受相同程序相比，死亡率（或1.64,95％CI 1.22-2.24; p = 0.0012）。此外，与在初步入场时的非框患者相比，脆弱患者的住院时间显着增加（P <0.0001）和所有付费者医院成本（P <0.0001）。然而，在所有入院时间点的感染率，血栓栓塞，CSF泄漏，多云撕裂，脑梗塞，急性肾损伤和死亡率之间没有发现虚线和非框架患者之间没有显着差异。结论脆弱可能会显着提高收缩患者对初级CNS肿瘤的颅神经外科患者短期急性并发症的风险。长期分析揭示了虚弱与非饲养患者之间的并发症的显着差异。有权进一步研究，了解老年患者体外脆弱的影响和时间表。
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