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Original Article   

Journal of Neurosurgical Sciences 2022 Apr 13

DOI: 10.23736/S0390-5616.22.05720-4


language: English

Frailty is a risk factor for intracranial abscess and is associated with longer length of stay: a retrospective single institution case-control study

Jose F. DOMINGUEZ 1 , Tolga SURSAL 1, Syed F. KAZIM 2, Christina NG 3, Sima VAZQUEZ 3, Ankita DAS 3, Alexandria NAFTCHI 3, Eris SPIROLLARI 3, Yuval ELKUN 3, Stergios GATZOFLIAS 3, Leonel AMPIE 4, Eric FELDSTEIN 1, Anaz UDDIN 3, Nitesh DAMODARA 1, Simon J. HANFT 1, Chirag D. GANDHI 1, Christian A. BOWERS 2

1 Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA; 2 Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA; 3 New York Medical College, Valhalla, NY, USA; 4 Department of Neurosurgery, University of Virginia-National Institute of Health, Bethesda, MD, USA

BACKGROUND: Intracranial abscess (IA) causes significant morbidity and mortality. The impact of baseline frailty status on post-operative outcomes of IA patients remains largely unknown. The present study evaluated if frailty status can be used to prognosticate outcomes in IA patients.
METHODS: We retrospectively reviewed all IA patients undergoing craniotomy at our institution from 2011 to 2018 (n =18). These IA patients were age and gender matched with patients undergoing craniotomy for intracranial tumor (IT), an internal control for comparison. Demographic and clinical data were collected to measure frailty, using the modified frailty index-11 (mFI-11), pre-operative American Society of Anesthesiologists Physical Status Classification System (ASA), and study their association with post-operative complications, as measured by the Clavien-Dindo Grade (CDG).
RESULTS: No significant difference in mFI-11 or ASA score was observed between the IA and IT groups (p = 0.058 and p = 0.131, respectively). IA patients had significantly higher CDG as compared with the control IT patients (p < 0.001). There was a trend towards increasing LOS in the IA group as compared to the IT group (p = 0.053). Increasing mFI and ASA were significant predictors of LOS by multiple linear regression in the IA group (p = 0.006 and p = 0.001, respectively), but not in the control IT group. Neither mFI-11 nor ASA were found to be predictors for CDG in either group. Within this case-control group of patients, we found an increase for odds of having IA with increasing mFI (OR 1.838, CI 95% 1.016-3.362, p = 0.044).
CONCLUSIONS: Frail IA patients tend to have more severe postoperative complications. The mFI-11 seems to predict increased resource utilization in the form of LOS. This study provides the initial retrospective data of another neurosurgical pathology where frailty leads to significantly worse outcomes. We also found that mFI may serve as a potential risk factor for severe disease.

KEY WORDS: Abscess; Craniotomy; Frailty; Outcomes

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