Impact of Frailty on Surgical Outcomes of Patients With Cushing Disease Using the Multicenter Registry of Adenomas of the Pituitary and Related Disorders Registry.

Autor:	Findlay MC; Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.; School of Medicine, University of Utah, Salt Lake City, Utah, USA., Rennert RC; Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA., Lucke-Wold B; Department of Neurosurgery, University of Florida, Gainesville, Florida, USA., Couldwell WT; Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA., Evans JJ; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Collopy S; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Kim W; Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA., Delery W; Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA., Pacione DR; Department of Neurosurgery, Lagone Medical Center, New York University, New York, New York, USA., Kim AH; Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA., Silverstein JM; Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA.; Division of Endocrinology, Metabolism & Lipid Research, Washington University School of Medicine, St. Louis, Missouri, USA., Kanga M; Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA., Chicoine MR; Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA., Gardner PA; Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Valappil B; Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Abdallah H; Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Sarris CE; Department of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Hendricks BK; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA., Torok IE; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA., Low TM; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA., Crocker TA; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA., Yuen KCJ; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA., Vigo V; Department of Neurosurgery, The Ohio State University, Columbus, Ohio, USA., Fernandez-Miranda JC; Department of Neurosurgery, Stanford University, Palo Alto, California, USA., Kshettry VR; Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio, USA., Little AS; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA., Karsy M; Global Neurosciences Institute, Philadelphia, Pennsylvania, USA.; Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
Jazyk:	angličtina
Zdroj:	Neurosurgery [Neurosurgery] 2024 Jul 10. Date of Electronic Publication: 2024 Jul 10.
DOI:	10.1227/neu.0000000000003090
Abstrakt:	Background and Objectives: Despite growing interest in how patient frailty affects outcomes (eg, in neuro-oncology), its role after transsphenoidal surgery for Cushing disease (CD) remains unclear. We evaluated the effect of frailty on CD outcomes using the Registry of Adenomas of the Pituitary and Related Disorders (RAPID) data set from a collaboration of US academic pituitary centers. Methods: Data on consecutive surgically treated patients with CD (2011-2023) were compiled using the 11-factor modified frailty index. Patients were classified as fit (score, 0-1), managing well (score, 2-3), and mildly frail (score, 4-5). Univariable and multivariable analyses were conducted to examine outcomes. Results: Data were analyzed for 318 patients (193 fit, 113 managing well, 12 mildly frail). Compared with fit and managing well patients, mildly frail patients were older (mean ± SD 39.7 ± 14.2 and 48.9 ± 12.2 vs 49.4 ± 8.9 years, P < .001) but did not different by sex, race, and other factors. They had significantly longer hospitalizations (3.7 ± 2.0 and 4.5 ± 3.5 vs 5.3 ± 3.5 days, P = .02), even after multivariable analysis (β = 1.01, P = .007) adjusted for known predictors of prolonged hospitalization (age, Knosp grade, surgeon experience, American Society of Anesthesiologists grade, complications, frailty). Patients with mild frailty were more commonly discharged to skilled nursing facilities (0.5% [1/192] and 4.5% [5/112] vs 25% [3/12], P < .001). Most patients underwent gross total resection (84.4% [163/193] and 79.6% [90/113] vs 83% [10/12]). No difference in overall complications was observed; however, venous thromboembolism was more common in mildly frail (8%, 1/12) than in fit (0.5%, 1/193) and managing well (2.7%, 3/113) patients (P = .04). No difference was found in 90-day readmission rates. Conclusion: These results demonstrate that mild frailty predicts CD surgical outcomes and may inform preoperative risk stratification. Frailty-influenced outcomes other than age and tumor characteristics may be useful for prognostication. Future studies can help identify strategies to reduce disease burden for frail patients with hypercortisolemia. (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu