Preoperative Frailty Risk in Cranioplasty Patients: Risk Analysis Index Predicts Adverse Outcomes.

Autor:	Moya AN; From the University of New Mexico School of Medicine, Albuquerque, N.M., Owodunni OP; Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, N.M., Harrison JL; Department of Surgery, Division of Plastic, Reconstructive, Hand and Burn Surgery, University of New Mexico School of Medicine, Albuquerque, N.M., Shahriari SR; Department of Surgery, Division of Plastic, Reconstructive, Hand and Burn Surgery, University of New Mexico School of Medicine, Albuquerque, N.M., Shetty AK; Department of Surgery, Division of Plastic, Reconstructive, Hand and Burn Surgery, University of New Mexico School of Medicine, Albuquerque, N.M., Borah GL; Department of Surgery, Division of Plastic, Reconstructive, Hand and Burn Surgery, University of New Mexico School of Medicine, Albuquerque, N.M., Schmidt MH; Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, N.M., Bowers CA; Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, N.M.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery. Global open [Plast Reconstr Surg Glob Open] 2023 Jun 21; Vol. 11 (6), pp. e5059. Date of Electronic Publication: 2023 Jun 21 (Print Publication: 2023).
DOI:	10.1097/GOX.0000000000005059
Abstrakt:	Cranioplasty is a common surgical procedure used to repair cranial defects, and it is associated with significant morbidity and mortality. Although frailty is a strong predictor of poor postoperative outcomes across surgical specialties, little is known about frailty's impact on cranioplasty outcomes. This study examined the association between frailty and cranioplasty by comparing the effect of the Risk Analysis Index-Administrative (RAI-A) and the Modified Frailty Index-5 (mFI-5) on cranioplasty outcomes. Methods: The National Surgical Quality Improvement Program was queried for patients undergoing cranioplasty between 2012 and 2020. Receiver operating characteristics and multivariable analyses were used to assess the relationship of postoperative outcomes and the RAI-A, mFI-5, and increasing patient age. Results: There were 2864 included study patients with a median age of 57 years (IQR, 44-67), and a higher proportion of patients were women (57.0%) and White (68.5%). The RAI-A had a more robust predictive ability for 30-day mortality (C-Statistic, 0.741; 95% confidence interval (CI), 0.678-0.804) compared with mFI-5 (C-Statistic, 0.574; 95% CI, 0.489-0.659) and increasing patient age (C-Statistic, 0.671; 95% CI, 0.610-0.732). On multivariable analyses, frailty was independently associated with mortality and other poor postoperative outcomes ( P < 0.05). Conclusions: The RAI-A demonstrated superior discrimination than the mFI-5 and increasing patient age in predicting mortality. Additionally, the RAI-A showed independent associations with nonhome discharge and postoperative complications (CDII, CDIIIb, and CDIV). The high rates of operative morbidity (5.0%-36.5%) and mortality (0.4%-3.2%) after cranioplasty highlight the importance of identifying independent risk factors for poor cranioplasty outcomes. Competing Interests: The authors have no financial interest to declare in relation to the content of this article. (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
Databáze:	MEDLINE
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