PDF(Pubmed)
Abstract：
UNASSIGNED: Postoperative complications after cranial or spine surgery are prevalent, and frailty can be a key contributing patient factor. Therefore, we evaluated frailty\'s impact on 30-day mortality. We compared the discrimination for risk analysis index (RAI), modified frailty index-5 (mFI-5) and increasing patient age for predicting 30-day mortality.
UNASSIGNED: Patients with major complications following neurosurgery procedures between 2012- 2020 in the ACS-NSQIP database were included. We employed receiver operating characteristic (ROC) curve and examined discrimination thresholds for RAI, mFI-5, and increasing patient age for 30-day mortality. Independent relationships were examined using multivariable analysis.
UNASSIGNED: There were 19,096 patients included in the study and in the ROC analysis for 30-day mortality, RAI showed superior discriminant validity threshold C-statistic 0.655 (95% CI: 0.644-0.666), compared to mFI-5 C-statistic 0.570 (95% CI 0.559-0.581), and increasing patient age C-statistic 0.607 (95% CI 0.595-0.619). When the patient population was divided into subsets based on the procedures type (spinal, cranial or other), spine procedures had the highest discriminant validity threshold for RAI (Cstatistic 0.717). Furthermore, there was a frailty risk tier dose response relationship with 30-day mortalityy (p<0.001).
UNASSIGNED: When a major complication arises after neurosurgical procedures, frail patients have a higher likelihood of dying within 30 days than their non-frail counterparts. The RAI demonstrated a higher discriminant validity threshold than mFI-5 and increasing patient age, making it a more clinically relevant tool for identifying and stratifying patients by frailty risk tiers. These findings highlight the importance of initiatives geared toward optimizing frail patients, to mitigate long-term disability.
UNASSIGNED: Patients with major complications following neurosurgery procedures between 2012- 2020 in the ACS-NSQIP database were included. We employed receiver operating characteristic (ROC) curve and examined discrimination thresholds for RAI, mFI-5, and increasing patient age for 30-day mortality. Independent relationships were examined using multivariable analysis.
UNASSIGNED: There were 19,096 patients included in the study and in the ROC analysis for 30-day mortality, RAI showed superior discriminant validity threshold C-statistic 0.655 (95% CI: 0.644-0.666), compared to mFI-5 C-statistic 0.570 (95% CI 0.559-0.581), and increasing patient age C-statistic 0.607 (95% CI 0.595-0.619). When the patient population was divided into subsets based on the procedures type (spinal, cranial or other), spine procedures had the highest discriminant validity threshold for RAI (Cstatistic 0.717). Furthermore, there was a frailty risk tier dose response relationship with 30-day mortalityy (p<0.001).
UNASSIGNED: When a major complication arises after neurosurgical procedures, frail patients have a higher likelihood of dying within 30 days than their non-frail counterparts. The RAI demonstrated a higher discriminant validity threshold than mFI-5 and increasing patient age, making it a more clinically relevant tool for identifying and stratifying patients by frailty risk tiers. These findings highlight the importance of initiatives geared toward optimizing frail patients, to mitigate long-term disability.
摘要：
■颅骨或脊柱手术后并发症很普遍，和脆弱可以是一个关键的影响患者的因素。因此,我们评估了虚弱对30天死亡率的影响。我们比较了风险分析指数(RAI)的区别性，修正的虚弱指数-5（mFI-5）和增加患者年龄预测30天死亡率。
■纳入ACS-NSQIP数据库中2012-2020年间神经外科手术后出现重大并发症的患者。我们采用了接收器工作特性(ROC)曲线，并检查了RAI的判别阈值，mFI-5和增加患者年龄的30天死亡率。使用多变量分析检查独立关系。
■有19,096名患者被纳入研究和30天死亡率的ROC分析，RAI显示出优于判别效度阈值C统计量0.655（95％CI：0.644-0.666），与mFI-5C统计0.570（95%CI0.559-0.581）相比，并增加患者年龄C统计量0.607（95％CI0.595-0.619）。当患者人群根据手术类型(脊柱，颅骨或其他)，脊柱手术对RAI的判别有效性阈值最高(Cstatistics0.717).此外，30日死亡率与虚弱风险层剂量反应相关(p<0.001).
■当神经外科手术后出现重大并发症时，虚弱的患者在30天内死亡的可能性高于非虚弱的患者。RAI显示出比mFI-5更高的判别有效性阈值和增加的患者年龄，使其成为一种更具临床相关性的工具，用于根据脆弱的风险等级识别和分层患者。这些发现强调了旨在优化虚弱患者的举措的重要性，减轻长期残疾。
■纳入ACS-NSQIP数据库中2012-2020年间神经外科手术后出现重大并发症的患者。我们采用了接收器工作特性(ROC)曲线，并检查了RAI的判别阈值，mFI-5和增加患者年龄的30天死亡率。使用多变量分析检查独立关系。
■有19,096名患者被纳入研究和30天死亡率的ROC分析，RAI显示出优于判别效度阈值C统计量0.655（95％CI：0.644-0.666），与mFI-5C统计0.570（95%CI0.559-0.581）相比，并增加患者年龄C统计量0.607（95％CI0.595-0.619）。当患者人群根据手术类型(脊柱，颅骨或其他)，脊柱手术对RAI的判别有效性阈值最高(Cstatistics0.717).此外，30日死亡率与虚弱风险层剂量反应相关(p<0.001).
■当神经外科手术后出现重大并发症时，虚弱的患者在30天内死亡的可能性高于非虚弱的患者。RAI显示出比mFI-5更高的判别有效性阈值和增加的患者年龄，使其成为一种更具临床相关性的工具，用于根据脆弱的风险等级识别和分层患者。这些发现强调了旨在优化虚弱患者的举措的重要性，减轻长期残疾。
