255 Frailty Is Associated With Decreased 365-day Survival in Adult Patients With Operative and Nonoperative Traumatic Subdural Hemorrhage

Abstract

INTRODUCTION: Traumatic subdural hematoma (tSDH) is observed frequently in traumatic brain injury (TBI) patients and is one of the commonest neurosurgical emergencies. tSDH patients require rapid evaluation and treatment in order to achieve the best possible results. There is a paucity of literature on frailty’s impact in TBI patients. METHODS: We performed a retrospective review of tSDH patients in the ACS-TQIP® database between 2007-2020. We employed multivariable regression models to examine the independent relationship of frailty, identified by the modified frailty index-5 (mFI-5) with the endpoints of major complications, length of stay (LOS), mortality, and discharge to a higher level of care. Additionally, we employ Kaplan-Meier (K-M) plots to examine the probability of survival following tSDH across the various mFI-5 frailty risk strata. RESULTS: 340,096 patients were managed nonoperatively and 41,658 operatively. The median age of the patients was 70.0 (IQR: 54.0, 81.0) nonoperative, and 71.0 (57.0, 80.0) operative cohorts. Multivariate analysis demonstrates a stepwise dose response relationship with outcomes p < 0.001. In both cohorts, there was an 18-86% in mortality i.e. nonoperative: frail (OR: 1.18 [95% CI 1.13, 1.23]), very frail (OR: 1.75 [95% CI 1.65, 1.86]); and operative: frail (OR: 1.21 [95% CI 1.12, 1.32]), very frail (OR: 1.86 [95% CI 1.66, 2.09]). Survival probability markedly decreased across frailty strata within the first 100 days. CONCLUSIONS: Frailty was associated with major complications, LOS, mortality, and discharge to a higher-level care facility in patients with tSDH. Rapid deployment of point of care frailty risk-assessment allows clinicians to improve prognostication for patients and their families and allocate resources more precisely in order to try to achieve better outcomes.