473 The Impact of Frailty on Traumatic Brain Injury Outcomes: An Analysis of 691,821 Nationwide Cases

Abstract

INTRODUCTION: Earlier research has demonstrated that patient frailty, a decline in physiologic reserve, is associated with higher morbidity and mortality for several neurosurgical conditions. However, the impact of frailty on traumatic brain injury (TBI) outcomes is poorly characterized. METHODS: We identified all adult admissions for traumatic intracranial hemorrhage (tICH) in the National Trauma Data Bank from 2007-2017. Frailty was quantified via the validated mFI-5 metric (0-5), with mFI-5 =2 denoting frailty. Analyzed outcomes included in-hospital mortality, favorable discharge disposition (discharge home or to short-term care), complications, ventilator days, and intensive care unit (ICU) and total length of stay (LOS). Multivariable regression was used to assess the association between mFI-5 and outcomes, adjusting for patient demographics (age, sex, insurance, transfer status), hospital characteristics (teaching status, trauma center level, bed size), injury severity on admission (penetrating injury, Glasgow Coma Scale [GCS], Injury Severity Score, hypotension, number of tICH subtypes), and neurosurgical procedures. RESULTS: 691,821 tICH admissions were analyzed. 63.2% were male and average age was 57.6 years (standard deviation=21.2). 43.5% were above 65 years of age. 18.0% of patients were classified as frail (mFI-5 = 2), and the percentage of frail patients grew from 7.9% in 2007 to 21.9% in 2017. Frailty was associated with increased odds of mortality (odds ratio [OR] = 1.36, P < 0.001) and decreased odds of favorable discharge disposition (OR = 0.72, P < 0.001). Frail patients also exhibited an elevated rate of complications (OR = 1.06, P < 0.001), including unplanned return to the ICU (OR = 1.55, P < 0.001) and operating room (OR = 1.17, P = 0.003). Finally, ventilator days (+12%, P < 0.001), ICU LOS (+11%, P < 0.001), and total LOS (+13%, P < 0.001) were significantly higher in frail patients. All associations with death and disposition remained significant following stratification for age, polytrauma, ICU stay, and GCS on admission. CONCLUSION: For tICH patients, frailty was associated with elevated mortality, unfavorable discharge disposition, complications, ventilator days, and LOS, regardless of age or injury severity. Further research into integrated care pathways for this high-risk population is warranted.