Resident Physician University of New Mexico Albuquerque, NM, US
Introduction: Metastatic brain tumors are the most prevalent type of intracranial neoplasm and have considerable impact on patient quality of life. The objective of the present study was to evaluate the prognostic ability of baseline frailty (as measured by Risk Analysis Index [RAI] for prediction of mortality or comfort care within 30-days of surgical resection of metastatic brain tumors.
Methods: Patients with surgically treated metastatic brain tumors were queried from the National Surgical Quality Improvement Database (NSQIP, 2012-2020). Patients with ICD-9-CM code 198.3 or ICD-10-CM code C79.31 with concomitant primary CPT codes 61510, 61518, 61520, 61521, 61526, 61530 were included. Baseline frailty was quantified using the RAI score and its statistical association with clinical endpoints evaluated. Receiver operating characteristic (ROC) curve analysis was employed to evaluate discriminatory accuracy.
Results: The cohort was composed of 11,039 patients, stratified into 889 robust (8.1%), 1019 normal (9.2%), 8233 frail (75%), and 897 severely frail (8.1%). There were 669 major complications (6.1%), 477 Clavien-Dindo grade IV complications (CD-IV, 4.3%), 2527 non-home discharges (NHD, 23%), and 464 patients with 30-day mortality (4.2%). RAI>40 was associated with higher rates of major complications (9.1% vs. 5.8%), CD-IVs (7.4% vs. 4.1%), eLOS (42% vs. 24%), NHDs (43% vs. 21%), and 30-day mortality (13% vs. 3.5%) (all P< 0.001). Rate of 30-day mortality (primary endpoint) was positively associated with increasing RAI tier: 1.3% in robust, 3.7% in normal, 3.7% in frail, and 12.6% in severely frail. RAI demonstrated superior predictive discrimination (C-statistic 0.65, 95% CI: 0.65-0.66) compared to age and mFI-5 (P < 0.001 per Delong test).
Conclusion : Baseline frailty (quantified by RAI) is a robust predictor of adverse outcomes after surgical resection of metastatic brain tumors. The findings exemplify the utility of this clinically translatable frailty index and provide guidance for future studies and quality improvement initiatives.
