Medical Student University of Wisconsin School of Medicine and Public Health New Berlin, Wisconsin, United States
Introduction: Frailty is associated with adverse outcomes in older patients undergoing non-emergent neurosurgery. Several tools have been developed to assess frailty, but most require data outside of a typical clinical encounter. Interventions that improve the assessment of frailty in the clinical setting may be useful in improving outcomes in frail older adults. This is a systematic review of available tools to assess frailty in the preoperative period for older adults undergoing elective neurosurgery.
Methods: The electronic databases Ovid MEDLINE, CINAHL, the Cochrane Database of Systematic Reviews, Psychology, and behavioral science collection, and PubMed were searched for papers reporting preoperative assessment of frailty in neurosurgical patients. Primary research papers with frailty reported in the preoperative period were included if they were original research and patients underwent elective surgery. Articles were excluded if they were review articles, reports, commentary, abstracts, presentations, not in English, or only reported frailty after surgery.
Results: The search yielded 661 articles. 34 studies, both prospective and retrospective, with 179,589 participants were included in this review. The number of participants in the included studies ranged from 61 to 52,671. The Newcastle-Ottawa-Scale, used to assess the quality of studies, found 33 of 34 studies to be good quality. Studies included the following surgery types: spine (n= 21); cranial (n=9); and oncology (n= 4). The tools used most often to measure frailty were the modified frailty index (mFi) in 22 studies, followed by adult spinal deformity frailty index (ASD-FI) in 3 studies. Overall frailty was associated with adverse outcomes, including composite post-surgical complications, mortality, length of stay, and discharge disposition.
Conclusion : With the increasing literature being published on frailty and neurosurgical outcomes, we present an updated systematic review of 34 varied studies. With increased data supporting the predictive power of frailty, neurosurgeons can use tools with existing clinical variables to better evaluate preoperative risk.
