Introduction

Frailty is a measure of physiologic reserve that is frequently cited as a predictor of postoperative complications. However, the effect of frailty on patients undergoing a relatively common procedure such as transsphenoidal resection of pituitary tumors (TSRPT) is unknown. Therefore, we sought to explore this relationship using a large, national database.

Methods

The 2006–2014 American College of Surgeons National Surgical Quality Improvement Program database was retrospectively reviewed to identify all patients who underwent TSRPT. Frailty scores were assigned using the established 11-factor modified Frailty Index (mFI-11). Patients were divided into low-frailty and high-frailty groups, based on mFI comorbidities of ≤ 1 and ≥ 2, respectively. Univariable and multivariable analyses were performed to evaluate the impact of frailty on postoperative outcomes and mortality.

Results

A total of 993 patients were included in the analysis. The low-frailty group consisted of 825 patients; the high-frailty group comprised 168 patients. In univariable analysis, there were no significant differences in medical (low-frailty 4.8%, high-frailty 8.3%; p = 0.069) and surgical (low-frailty 1.1%, high-frailty 1.2%; p = 1.000) complications; however, the high-frailty group had a higher rate of mortality (3%) when compared with the low-frailty group (0.6%; p = 0.016, OR 4.07, p = 0.044) and longer hospitalization (4.5 ± 7.4 vs. 5.8 ± 6.8 days; p = 0.023). In multivariable analysis, frailty was a predictor of mortality but not complications or reoperation.

Conclusions

Our study shows that frailty, as measured by the mFI-11, does not predict postoperative complications in patients who undergo TSRPT, but greater frailty is correlated with higher mortality and increased hospital length of stay.

中文翻译：

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改良虚弱指数11（mFI-11）对垂体瘤经蝶窦切除术患者术后并发症的影响：2006-2014年ACS-NSQIP数据库分析

介绍

虚弱是生理储备的衡量标准，经常被引用作为术后并发症的预测指标。然而，虚弱对接受诸如经蝶窦垂体瘤切除术 (TSRPT) 等相对常见手术的患者的影响尚不清楚。因此，我们试图使用一个大型的国家数据库来探索这种关系。

方法

回顾性审查了 2006-2014 年美国外科医师学会国家外科质量改进计划数据库，以确定所有接受 TSRPT 的患者。使用已建立的 11 因素修正虚弱指数 (mFI-11) 分配虚弱评分。根据 mFI 合并症分别≤ 1 和≥ 2，将患者分为低虚弱组和高虚弱组。进行单变量和多变量分析以评估虚弱对术后结果和死亡率的影响。

结果

共有 993 名患者被纳入分析。低衰弱组由 825 名患者组成；高虚弱组包括 168 名患者。在单变量分析中，内科（低虚弱 4.8%，高虚弱 8.3%；p  = 0.069）和手术（低虚弱 1.1%，高虚弱 1.2%；p  = 1.000）并发症没有显着差异；然而，与低衰弱组（0.6%；p  = 0.016，OR 4.07，p  = 0.044）相比，高衰弱组的死亡率（3%）更高，住院时间更长（4.5 ± 7.4 vs. 5.8 ± 6.8 天；p  = 0.023)。在多变量分析中，虚弱是死亡率的预测因子，但不是并发症或再次手术的预测因子。

结论

我们的研究表明，由 mFI-11 衡量的虚弱并不能预测接受 TSRPT 的患者的术后并发症，但更虚弱与更高的死亡率和住院时间增加相关。