Trends in frailty in brain tumor care during the COVID-19 pandemic in a nationwide hospital network in Germany.

Autor: Hong B; Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany.; Department of Neurosurgery, Hannover Medical School, Hannover, Germany.; Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Pieskower Strasse 33, 15526, Bad Saarow, Germany., Allam A; Department of Anesthesiology and Intensive Care Medicine, HELIOS Hospital Bad Saarow, Bad Saarow, Germany.; Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Pieskower Strasse 33, 15526, Bad Saarow, Germany., Heese O; Department of Neurosurgery, HELIOS Hospital Schwerin, Schwerin, Germany., Gerlach R; Department of Neurosurgery, HELIOS Hospital Erfurt, Erfurt, Germany., Gheewala H; Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany.; Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Pieskower Strasse 33, 15526, Bad Saarow, Germany., Rosahl SK; Department of Neurosurgery, HELIOS Hospital Erfurt, Erfurt, Germany., Stoffel M; Department of Neurosurgery, HELIOS Hospital Krefeld, Krefeld, Germany., Ryang YM; Department of Neurosurgery and Center for Spine Therapy, HELIOS Hospital Berlin Buch, Berlin, Germany.; Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany., Burger R; Department of Neurosurgery, HELIOS Hospital Uelzen, Uelzen, Germany., Carl B; Department of Neurosurgery, University of Marburg, Marburg, Germany.; Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany.; Department of Neurosurgery, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany., Kristof RA; Department of Neurosurgery, HELIOS Hospital Meiningen, Meiningen, Germany., Westermaier T; Department of Neurosurgery, HELIOS Hospital Dachau, Dachau, Germany., Terzis J; Department of Neurosurgery, HELIOS University Hospital Wuppertal, Wuppertal, Germany., Youssef F; Department of Neurosurgery, HELIOS Hospital Plauen, Plauen, Germany., Kuhlen R; HELIOS Health GmbH, Berlin, Germany., Hohenstein S; Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany., Bollmann A; Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany.; Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany., Dengler J; Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany. julius.dengler@helios-gesundheit.de.; Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Pieskower Strasse 33, 15526, Bad Saarow, Germany. julius.dengler@helios-gesundheit.de.
Jazyk: angličtina
Zdroj: European geriatric medicine [Eur Geriatr Med] 2023 Dec; Vol. 14 (6), pp. 1383-1391. Date of Electronic Publication: 2023 Nov 13.
DOI: 10.1007/s41999-023-00880-0
Abstrakt: Purpose: Among brain tumor patients, frailty is associated with poor outcomes. The COVID-19 pandemic has led to increased frailty in the general population. To date, evidence on changes in frailty among brain tumor patients during the pandemic is lacking. We aimed to compare frailty among brain tumor patients in Germany during the COVID-19 pandemic to the pre-pandemic era and to assess potential effects on brain tumor care.
Methods: In this retrospective observational study, we compared frailty among brain tumor patients hospitalized during the COVID-19 pandemic in years 2020 through 2022 to pre-pandemic years 2016 through 2019 based on administrative data from a nationwide network of 78 hospitals in Germany. Using the Hospital Frailty Risk Score (HFRS), frailty was categorized as low, intermediate, or high. We examined changes in frailty, patient demographics, the burden of comorbidity, rates of surgery, and mortality rates for different frailty groups during the pandemic and compared them to pre-pandemic levels.
Results: Of the 20,005 included hospitalizations for brain tumors, 7979 were during the pandemic (mean age 60.0 years (± 18.4); females: 49.8%), and 12,026 in the pre-pandemic period (mean age: 59.0 years [± 18.4]; females: 49.2%). Average daily admissions decreased from 8.2 (± 5.1) during pre-pandemic years to 7.3 (± 4.5) during the pandemic (p < 0.01). The overall median HFRS decreased from 3.1 (IQR: 0.9-7.3) during the pre-pandemic years to 2.6 (IQR: 0.3-6.8) during the pandemic (p < 0.01). At the same time, the Elixhauser Comorbidity Index (ECI) decreased from 17.0 (± 12.4) to 16.1 (± 12.0; p < 0.01), but to a larger degree among high compared to low frailty cases (by 1.8 vs. 0.3 points; p = 0.04). In the entire cohort, the mean length of stay was significantly shorter in the pandemic period (9.5 days [± 10.7]) compared with pre-pandemic levels (10.2 days [± 11.8]; p < 0.01) with similar differences in the three frailty groups. Rates of brain tumor resection increased from 29.9% in pre-pandemic years to 36.6% during the pandemic (p < 0.001) without differences between frailty levels. Rates of in-hospital mortality did not change during the pandemic (6.1% vs. 6.7%, p = 0.07), and there was no interaction with frailty.
Conclusion: Even though our findings are limited in that the HFRS is validated only for patients ≥ 75 years of age, our study among patients of all ages hospitalized for brain tumors in Germany suggests a marked decrease in levels of frailty and in the burden of comorbidities during the COVID-19 pandemic.
(© 2023. The Author(s).)
Databáze: MEDLINE
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