The impact of frailty on patient selection and outcomes for open versus endovascular treatment of unruptured intracranial aneurysms: A propensity-score matched analysis.

Autor: Roy JM; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA., Musmar B; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA., Patil S; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA., Majmundar S; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA., Patel S; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA., Tjoumakaris SI; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA., Gooch MR; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA., Rosenwasser RH; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA., Bowers C; Hurley Medical Center, Flint, MI, USA., Jabbour PM; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: pascal.jabbour@jefferson.edu.
Jazyk: angličtina
Zdroj: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia [J Clin Neurosci] 2024 Dec 17; Vol. 132, pp. 110988. Date of Electronic Publication: 2024 Dec 17.
DOI: 10.1016/j.jocn.2024.110988
Abstrakt: Background and Objectives: Endovascular treatment (EVT) has been demonstrated to have improved post-operative outcomes and fewer complications compared to open microsurgical clipping of unruptured intracranial aneurysms (UIAs). Our study analyzes patient selection and outcomes for open versus EVT stratified by frailty measured using the Risk Analysis Index (RAI).
Methods: This was a retrospective study of patients who underwent open or EVT for an UIA at our institution between March 2017 and June 2022. Propensity-score matching (PSM) was performed using the 1:1 nearest neighbour method to create two groups (open and EVT) matched by demographics and treatment modality. RAI-measured frailty was used to categorize patients into 4 tiers: robust (0-10), pre-frail (11-20), frail (21-30) and severely frail (≥31). Outcomes of interest were length of stay (LOS), functional dependence at discharge and 30-day readmission.
Results: After PSM, 209 patients were stratified into two groups, open and EVT, respectively. Patients who received EVT were older compared to open surgery (mean ± SD: 62.6 ± 11.4 vs. 60.8 ± 10.6, P < 0.05), however, RAI-measured frailty did not differ significantly between the two groups (median (IQR) open: 3 (2-7), vs. EVT: 3 (2-9)), P = 0.090. Among robust and pre-frail patients, EVT was associated with significantly shorter LOS compared to open surgery, median (IQR): 1 (1-2) vs. 3 (2-4) and 1 (1-2), vs. 3 (2-6); P < 0.001, respectively). Neither functional dependence at discharge nor 30-day readmission rates were different after stratification by frailty.
Conclusion: Patients in the robust and pre-frail tiers experienced significantly shorter LOS after EVT compared to open surgery. We would like to encourage the use of frailty assessment as a pre-operative risk stratification tool patients undergoing treatment of UIAs.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Jabbour is a consultant for Medtronic, MicroVention, Balt and Cerus Endovascular. Dr. Tjoumakaris is a consultant for MicroVention. Dr. Gooch is a consultant for Stryker. The other authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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