Frailty and pituitary surgery: a systematic review

Area of Science:

• Neurosurgery
• Geriatric Medicine
• Surgical Outcomes

Background:

• Frailty, a state of physiological vulnerability, increases risks for adverse perioperative outcomes in neurosurgery patients.
• The specific impact of frailty on transsphenoidal pituitary surgery outcomes and complications remains largely uncharacterized.

Purpose of the Study:

• To systematically review and synthesize the existing literature on the association between frailty and outcomes in patients undergoing transsphenoidal pituitary surgery.

Main Methods:

• A systematic literature review was conducted following PRISMA guidelines.
• Studies utilizing validated frailty metrics to assess outcomes in pituitary surgery patients were included.

Main Results:

• The review included 13 studies with 124,989 patients, noting heterogeneity in frailty assessment and definitions.
• Frail patients experienced significantly higher medical complication rates, longer hospital stays, increased costs, higher readmission rates, and greater mortality.
• Surgical outcomes, including biochemical remission, visual recovery, and quality of life, were not significantly impacted by frailty.

Conclusions:

• Frailty is a significant indicator of perioperative risk in pituitary surgery, affecting a minority of patients.
• Frailty assessment should guide perioperative risk mitigation strategies rather than serve as a contraindication for surgery.
• Proactive management of frailty can improve overall outcomes for patients undergoing transsphenoidal pituitary surgery.