Abstract
IntroductionFrailty is a state of decreased physiologic reserve associated with adverse treatment outcomes across surgical specialties. We sought to determine whether frailty affected patient outcomes after elective treatment (open microsurgical clipping or endovascular therapy [EVT]) of unruptured cerebral aneurysms (UCA). MethodsThe National Readmissions Database (NRD) was queried from 2010-2014 to identify patients who had known UCA and underwent elective clipping or EVT. Frailty was assessed using the Johns Hopkins Adjusted Clinical Groups frailty indicator tool. Multivariable exact logistic regression analyses were conducted to assess the associations between frailty and primary outcome variables of 30- and 90-day readmissions, complications, length of stay (LOS) and patient disposition. ResultsOut of 18,483 patients who underwent elective treatment for UCA, 358 (1.9%) met the criteria for frailty. After adjusting for patient and hospital-based factors, frailty (30-day: OR 1.55 95% CI 1.11-2.17, p=0.01; 90-day: OR 1.47 95% CI 1.05-2.06, p=0.02) and clipping (vs. EVT) (30-day: OR 2.12 95% CI 1.85-2.43, p<0.000; 90-day: OR 1.80 95% CI 1.59-2.03, p<0.0001) were associated with increased readmission rates. Furthermore, frailty was associated with increased complications (surgical: OR 2.91 95% Cl 2.27-3.72, p<0.0001; neurological: OR 3.04 95% Cl 2.43-3.81, p<0.0001; major: OR 2.75 95% Cl 1.96-3.84, p<0.0001), increased LOS (IRR 3.08 95% Cl 2.59-3.66, p<0.0001) and nonroutine disposition (OR 3.94 95% Cl 2.91-5.34, p<0.0001). ConclusionsFrailty was associated with increased likelihood of 30- and 90-day readmission after elective treatment for UCA. Frailty was notably associated with several postoperative complications, greater LOS, and non-routine disposition in the treatment of UCA.
Published Version
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