Medical Student Drexel University College of Medicine West Reading, Pennsylvania, United States
Introduction: A patient’s frailty, a clinical state of increased vulnerability measured by the 5-item modified frailty index (mFI-5), has been recognized as a significant determinant of peri-operative morbidity within surgical literature. This study aims to be the first assessment of the predictive value of the mFI-5 for postoperative morbidity and mortality following surgical drainage of a chronic subdural hematoma (cSDH).
Methods: A retrospective cohort study was performed on patients who underwent surgical drainage of a cSDH. The mFI-5 score was calculated for each patient and was used to stratify patients into three groups: pre-frail (mFI-5 < 2), frail (mFI-5=2), and severely frail (mFI-5>2). Multivariate logistic and linear regression analysis was used.
Results: A total of 118 patients with a mean age of 74.42±11.85 were analyzed. Other than younger age in the pre-frail group (71.99 vs 77.41, 77.88), all baseline demographics were similar across the three groups. Severely frail patients (N=24, 20.3%) had increased odds of 30-day readmission and non-home disposition in the univariate (UV) (HR 4.62, p< 0.001; HR 11.04, p< 0.001) and multivariate analyses (MV) (HR 4.29, p< 0.001; HR 9.64, p< 0.001). Patients in the severely frail group also had higher rates of new post-operative deficits (UV: HR 3.09, p= 0.02; MV: HR 2.75, p= 0.03) and hematoma reaccumulation (UV: HR 4.87, p< 0.001; MV: HR 4.07, p= 0.004). Additionally, these patients had worse overall survival odds in the univariate (HR 3.68, p< 0.001) and multivariate analyses (HR 3.11, p= 0.004). The pre-frail (N=67, 56.8%) and frail patients (N=27, 22.9%) had no significant difference in outcomes.
Conclusion : Frailty, measured by the mFI-5, holds a predictive value regarding outcomes for elderly patients undergoing surgical drainage of a cSDH. The mFI-5 can be used preoperatively to enhance risk stratification and identify high-risk patients prior to surgery.
