Frailty may accurately predict outcomes in patients undergoing vestibular schwannoma resection
The most frequent question asked is about the independent prognostic associations of chronological age and frailty (physiological age) with outcomes following vestibular schwannoma (VS) resection.
To answer this, Alis J. Dicpinigaitis and colleagues from the School of Medicine, New York Medical College, Valhalla, New York found out that frailty may be more accurate for predicting outcomes and guiding treatment decisions than advanced patient age alone following VS resection.
The research is published in the JAMA Otolaryngology- Head and Neck Surgery Journal.
Although numerous studies have evaluated the influence of advanced age on surgical outcomes following vestibular schwannoma (VS) resection, few if any large-scale investigations have assessed the comparative prognostic effects of age and frailty. As the population continues to age, it is imperative to further evaluate treatment and management strategies for older patients.
Therefore, the present study was conducted with the sole objective to conduct a population-based evaluation of the independent associations of chronological age and frailty (physiological age) with outcomes following VS resection.
In this large-scale, multicenter, cross-sectional analysis, weighted discharge data from the National Inpatient Sample were searched to identify adult patients (≥18 years old) who underwent VS resection using International Classification of Diseases, Ninth Revision, Clinical Modification and Tenth Revision, Clinical Modification codes. Data collection and analysis took place.
Complex samples regression models and receiver operating characteristic curve analysis were used to evaluate the independent associations of frailty and age (along with demographic confounders) with complications and discharge disposition. Frailty was evaluated using the previously validated 11-point modified frailty index (mFI).
The following findings were seen-
a. Among the 27 313 patients identified for VS resection, the mean (SEM) age was 50.4 (0.2) years, 15 031 (55.0%) were women, and 4720 (21.0%) were of non-White race/ethnicity, as determined by the National Inpatient Sample data source.
b. Of the included patients, 15 090 (55.2%) were considered robust (mFI score = 0), 8204 (30.0%) were prefrail (mFI score = 1), 3022 (11.1%) were frail (mFI score = 2), and 996 (3.6%) were severely frail (mFI score ≥3).
c. On univariable analysis, increasing frailty was associated with development of postoperative hemorrhagic or ischemic stroke (odds ratio [OR], 2.44 [95% CI, 2.07-2.87]; area under the curve, 0.73), while increasing age was not.
d. Following multivariable analysis, increasing frailty and non-White race/ethnicity were independently associated with both mortality (adjusted OR [aOR], 2.32 [95% CI, 1.70-3.17], and aOR, 3.05 [95% CI, 1.02-9.12], respectively) and extended hospital stays (aOR, 1.54 [95% CI, 1.41-1.67], and aOR, 1.71 [95% CI, 1.42-2.05], respectively), while increasing age was not.
e. Increasing frailty (aOR, 0.61 [95% CI, 0.56-0.67]), age (aOR, 0.98 [95% CI, 0.97-0.99]), and non-White race/ethnicity (aOR, 0.62 [95% CI 0.51-0.75]) were all independently associated with routine discharge.
Hence, the authors concluded that "frailty may be more accurate for predicting outcomes and guiding treatment decisions than advanced patient age alone following vestibular schwannoma (VS) resection."