Impact of Frailty on Outcomes following Endoscopic Endonasal Skull Base Surgery: A Prospective Cohort Analysis of 152 Patients

Introduction: With an aging population, elderly patients with multiple comorbidities are more frequently undergoing surgical intervention and are at an increased risk for complications. Therefore, developing strategies to preoperatively identify patients who may be at an increased risk of perioperative complications is essential. To this end, the objective measurement of a frailty score may predict the incidence of postoperative adverse events by using a previously validated simple and inexpensive questionnaire.

Methods: A retrospective review of prospectively collected cohort was performed. A quality improvement project was implemented that assessed clinical outcomes after elective endoscopic endonasal approaches (EEAs) to the cranial base from a quaternary care institution between May 2016 and October 2017. Frailty was assessed with the Risk Analysis Index (RAI), and patients were categorized as nonfrail (RAI 0–29) or prefrail/frail (RAI ≥ 30). Both the RAI considering the cancer status (C-RAI) and not considering it (NC-RAI) were analyzed. Blood loss, length of stay (LOS), surgical site infections, readmissions, and mortality were analyzed.

Results: Nonfrail patients had a shorter hospitalization compared with prefrail/frail patients (3.2 ± 3.3 days vs. 3.9 ±3.5 days, p < 0.001). Prefrail and frail patients were more likely to require admission to the ICU after surgery than nonfrail patients (17.4 vs. 11.4%, respectively, p < 0.05). The C-RAI showed a significant difference in mortality between nonfrail and prefrail/frail patients at 90 days (0 vs. 4.9%, p < 0.001) and 1 year (0 vs. 9.8%, p < 0.001), whereas the NC-RAI elicited a difference at 60 days (0 vs. 8.3%, p < 0.05), 90 days (0.7 vs. 8.3%, p < 0.05), and 1 year (1.4 vs. 16.7%, p < 0.05).

Conclusion: Frailty, measured using RAI, predicts mortality, length of stay and ICU requirement after endoscopic endonasal approaches, and is a useful and objective tool to assess perioperative risk in elderly patients undergoing this type of surgery.