Frailty as a Predictor of Postoperative Complications Following Skull Base Surgery

Area of Science:

• Neurosurgery
• Surgical Oncology
• Geriatrics

Background:

• Frailty is a recognized predictor of surgical outcomes.
• Its impact on skull base surgery outcomes remains unexamined.
• The 5-factor modified frailty index (mFI-5) is a validated frailty assessment tool.

Purpose of the Study:

• To evaluate the 5-factor modified frailty index (mFI-5) as a predictor of perioperative morbidity and mortality in skull base surgery.
• To assess the association between frailty and postoperative complications, including mortality.
• To determine if frailty impacts length of hospital stay.

Main Methods:

• Utilized the National Surgical Quality Improvement Program (NSQIP) database (2005-2018).
• Calculated mFI-5 scores for 17,912 patients undergoing skull base procedures.
• Employed multivariate logistic regression to analyze the association of frailty with 30-day postoperative outcomes, including subanalysis by operative location.

Main Results:

• Frailty (mFI-5 score ≥1) was present in 45.5% of patients.
• Frailty independently predicted overall complications (OR: 1.325), life-threatening complications (OR: 1.428), and mortality (OR: 1.453) (all P<.001).
• Higher frailty correlated with increased length of stay and complications in middle, posterior, and multiple-fossae surgeries, but not anterior fossa procedures.

Conclusions:

• Frailty significantly and progressively associates with severe postoperative morbidity, mortality, and extended hospital stays after skull base surgery.
• The mFI-5 is an objective, easily calculable preoperative risk assessment tool.
• This index can enhance perioperative planning and patient outcome counseling.