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CC BY 4.0 · Indian Journal of Neurosurgery 2024; 13(01): 035-043
DOI: 10.1055/s-0043-1770908
Original Article

Anterior Skull Base Outcomes and Complications: A Propensity Score–Matched Evaluation of Age and Frailty as Measured by mFI-5 from the ACS-NSQIP Database

Sawyer Bauer 
1   School of Medicine, Reno School of Medicine, University of Nevada, Reno, Nevada, United States
,
Matt Findlay 
2   School of Medicine, University of Utah, Salt Lake City, Utah, United States
,
Majid Khan 
3   School of Medicine, University of Nevada Reno, Nevada, United States
,
Hepzibha Alexander
4   Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Novi, Michigan, United States
,
Brandon Lucke-Wold
5   Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
,
Forrest Hamrick
6   Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States
,
Josh Hunsaker
6   Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States
,
Michael Karsy 
7   Department of Neurosurgery, Global Neurosciences Institute, Chester, Pennsylvania, United States
8   Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
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Abstract

Background Frailty is increasingly recognized as a predictor of surgical outcomes; however, its utility in anterior cranial fossa (ACF) surgery remains unclear. We analyzed whether age and frailty are independent predictors of outcomes after ACF surgery using a retrospective cohort study.

Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried, by Current Procedural Terminology codes, for ACF procedures in 2005 to 2020. Cases included open approaches, endoscopic approaches, and all tumor types except for pituitary adenoma. A propensity score–matched data set was analyzed via multiple logistic regression.

Results Unmatched multivariate analysis of ACF cases demonstrated that severe frailty (modified 5-item frailty index [mFI-5] ≥ 3) was independently associated with having any (odds ratio [OR] = 3.67) and minor (OR = 5.00) complications (both p < 0.001). Analysis of individual mFI-5 components demonstrated poor functional status was significantly associated with any (OR = 3.39), major (OR = 3.59), and minor (OR = 3.14) complications (all p < 0.001). After propensity score matching, only age was modestly impactful on minor complications (OR = 1.02) and extended length of stay (eLOS) (OR = 1.02) (p < 0.001). Frailty did not maintain its predictive ability after matching. Nonindependent functional status, as a subcomponent of mFI maintained significant predictive ability for any (OR = 4.94), major (OR = 4.68), and minor (OR = 4.80) complications and eLOS (OR = 2.92) (all p < 0.001).

Conclusion After propensity score matching, age demonstrated a greater ability to predict postoperative complications in ACF surgery than frailty. Rather than age or frailty, functional status served as a better outcome predictor and potential guide for patient counseling. Further validation of these findings in multicenter or disease-specific studies is warranted as well as aims to preoperatively improve functional status in ACF surgery.

Keywords

age - anterior cranial fossa - anterior skull base - complications - frailty - mFI-5 - modified 5-item frailty index - National Surgical Quality Improvement Program - neurosurgery - NSQIP - propensity score matching


Publication History

Article published online:
10 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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