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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Frailty Predicts Postoperative Functional Outcomes After Microsurgical Resection of Ruptured Brain Arteriovenous
Guilherme Barros1, Rajeev D Sen1, Margaret McGrath1
1Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
Objective:
To determine the effectiveness of the modified Frailty Index-5 (mFI-5) in predicting postoperative functional outcome after microsurgical resection of ruptured brain arteriovenous malformations (bAVMs).
Methods:
A retrospective review was performed of patients undergoing microsurgical resection of acutely ruptured bAVMs. Demographics, bAVM characteristics, mFI-5, Ruptured Arteriovenous Malformation Grading Scale (RAGS) score, and Spetzler-Martin (S-M) grade were recorded. Predictive ability of mFI-5 for postoperative functional outcome measured by modified Rankin Scale (mRS) was assessed with univariate and multivariate logistic and linear regression. RAGS score and S-M grade alone were compared with adding mFI-5 to either RAGS score or S-M grade using area under the curve (AUC) analysis.
Results:
In total, 109 patients were included. For every 1-point increase in mFI-5, there was a lower likelihood of good functional outcome (mRS score ≤2; odds ratio [OR], 0.33; confidence interval [CI], 0.15-0.60; P = 0.011). Healthy patients (mFI-5 = 0) were more likely to have good postoperative outcomes versus frail patients (mFI-5 ≥1) (OR, 3.32; CI, 1.24-8.97; P = 0.017). In multivariate analysis controlling for RAGS score, for every 1-point mFI-5 increase, there was a decreased likelihood of postoperative good functional outcome (OR, 0.32; CI, 0.14-0.63; P = 0.0026) and mFI-5 did not significantly predict secondary outcomes. S-M grade with mFI-5 showed better discrimination for postoperative good functional outcome (AUC 0.616), compared with S-M grade alone (AUC 0.544). RAGS score with mFI-5 showed the best discrimination for postoperative good functional outcome (AUC 0.798), compared with RAGS score alone (AUC 0.721).
Conclusions:
Measuring frailty with mFI-5 additive to established bAVM grading systems may improve assessment of individual patient likelihood of postoperative good functional outcome after hemorrhagic bAVM resection.
Insights
The modified Frailty Index-5 (mFI-5) effectively predicts functional outcomes after brain arteriovenous malformation (bAVM) surgery. Incorporating mFI-5 into grading systems like RAGS improves patient outcome prediction after hemorrhagic bAVM resection.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Geriatrics
Background:
- Microsurgical resection is a key treatment for ruptured brain arteriovenous malformations (bAVMs).
- Predicting postoperative functional outcomes is crucial for patient management.
- Frailty assessment is increasingly recognized as important in surgical outcomes.
Purpose of the Study:
- To evaluate the modified Frailty Index-5 (mFI-5) for predicting functional outcomes post-bAVM resection.
- To compare the predictive performance of mFI-5 with established grading scales (RAGS, S-M).
Main Methods:
- Retrospective review of 109 patients undergoing microsurgical resection of ruptured bAVMs.
- Data collected included demographics, bAVM characteristics, mFI-5, RAGS, and Spetzler-Martin (S-M) grade.
- Logistic and linear regression analyses assessed mFI-5's predictive ability for modified Rankin Scale (mRS) outcomes. Area Under the Curve (AUC) analysis compared grading systems with and without mFI-5.
Main Results:
- Higher mFI-5 scores correlated with lower likelihood of good functional outcome (mRS ≤2).
- Patients with mFI-5=0 had better outcomes than those with mFI-5 ≥1.
- Adding mFI-5 to RAGS score significantly improved prediction (AUC 0.798 vs. 0.721), outperforming S-M grade with mFI-5 (AUC 0.616 vs. 0.544).
Conclusions:
- The mFI-5 is a valuable tool for predicting functional outcomes after ruptured bAVM resection.
- Integrating mFI-5 with existing grading systems (RAGS, S-M) enhances the assessment of individual patient prognosis.
- This improved assessment aids in optimizing surgical decision-making and patient counseling.
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