Predicting Postoperative Outcomes in Brain Tumor Patients With a 5-Factor Modified Frailty Index

Abstract BACKGROUND Frailty indices may represent useful decision support tools to optimize modifiable drivers of quality and cost in neurosurgical care. However, classic indices are cumbersome to calculate and frequently require unavailable data. Recently, a more lean 5-factor modified frailty index (mFI-5) was introduced, but it has not yet been rigorously applied to brain tumor patients. OBJECTIVE To investigate the predictive value of the mFI-5 on length of stay (LOS), complications, and charges in surgical brain tumor patients. METHODS We retrospectively reviewed data for brain tumor patients who underwent primary surgery from 2017 to 2018. Bivariate (ANOVA) and multivariate (logistic and linear regression) analyses assessed the predictive power of the mFI-5 on postoperative outcomes. RESULTS Our cohort included 1692 patients with a mean age of 55.5 yr and mFI-5 of 0.80. Mean intensive care unit (ICU) and total LOS were 1.69 and 5.24 d, respectively. Mean pulmonary embolism (PE)/deep vein thrombosis (DVT), physiological/metabolic derangement, respiratory failure, and sepsis rates were 7.2%, 1.1%, 1.6%, and 1.7%, respectively. Mean total charges were $42 331. On multivariate analysis, each additional point on the mFI-5 was associated with a 0.32- and 1.38-d increase in ICU and total LOS, respectively; increased odds of PE/DVT (odds ratio (OR): 1.50), physiological/metabolic derangement (OR: 3.66), respiratory failure (OR: 1.55), and sepsis (OR: 2.12); and an increase in total charges of $5846. CONCLUSION The mFI-5 is a pragmatic and actionable tool which predicts LOS, complications, and charges in brain tumor patients. It may guide future efforts to risk-stratify patients with subsequent impact on postoperative outcomes.

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Commentary: Predicting Postoperative Outcomes in Brain Tumor Patients With a 5-Factor Modified Frailty Index

Neurosurgery ◽

10.1093/neuros/nyaa407 ◽

2020 ◽

Vol 88 (1) ◽

pp. E36-E38

Author(s):

Michael Zhang ◽

Melanie Hayden Gephart ◽

Corinna C Zygourakis

Keyword(s):

Brain Tumor ◽

Frailty Index ◽

Postoperative Outcomes ◽

Tumor Patients ◽

Modified Frailty Index

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Predicting Postoperative Outcomes in Brain Tumor Patients With a 5-Factor Modified Frailty Index

Neurosurgery ◽

10.1093/neuros/nyaa335_s068 ◽

2021 ◽

Vol 89 (Supplement_2) ◽

pp. S68-S68

Author(s):

Sakibul Huq ◽

Adham M Khalafallah ◽

Adrian E Jimenez ◽

Abhishek Gami ◽

Shravika Lam ◽

...

Keyword(s):

Brain Tumor ◽

Frailty Index ◽

Postoperative Outcomes ◽

Tumor Patients ◽

Modified Frailty Index

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The 5-factor modified frailty index: an effective predictor of mortality in brain tumor patients

Journal of Neurosurgery ◽

10.3171/2020.5.jns20766 ◽

2020 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Adham M. Khalafallah ◽

Sakibul Huq ◽

Adrian E. Jimenez ◽

Henry Brem ◽

Debraj Mukherjee

Keyword(s):

Brain Tumor ◽

Frailty Index ◽

Postoperative Mortality ◽

Roc Curves ◽

Study Cohort ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

Tumor Patients ◽

Significant Difference ◽

Modified Frailty Index

OBJECTIVEHealth measures such as the Charlson Comorbidity Index (CCI) and the 11-factor modified frailty index (mFI-11) have been employed to predict general medical and surgical mortality, but their clinical utility is limited by the requirement for a large number of data points, some of which overlap or require data that may be unavailable in large datasets. A more streamlined 5-factor modified frailty index (mFI-5) was recently developed to overcome these barriers, but it has not been widely tested in neuro-oncology patient populations. The authors compared the utility of the mFI-5 to that of the CCI and the mFI-11 in predicting postoperative mortality in brain tumor patients.METHODSThe authors retrospectively reviewed a cohort of adult patients from a single institution who underwent brain tumor surgery during the period from January 2017 to December 2018. Logistic regression models were used to quantify the associations between health measure scores and postoperative mortality after adjusting for patient age, race, ethnicity, sex, marital status, and diagnosis. Results were considered statistically significant at p values ≤ 0.05. Receiver operating characteristic (ROC) curves were used to examine the relationships between CCI, mFI-11, and mFI-5 and mortality, and DeLong’s test was used to test for significant differences between c-statistics. Spearman’s rho was used to quantify correlations between indices.RESULTSThe study cohort included 1692 patients (mean age 55.5 years; mean CCI, mFI-11, and mFI-5 scores 2.49, 1.05, and 0.80, respectively). Each 1-point increase in mFI-11 (OR 4.19, p = 0.0043) and mFI-5 (OR 2.56, p = 0.018) scores independently predicted greater odds of 90-day postoperative mortality. Adjusted CCI, mFI-11, and mFI-5 ROC curves demonstrated c-statistics of 0.86 (CI 0.82–0.90), 0.87 (CI 0.83–0.91), and 0.87 (CI 0.83–0.91), respectively, and there was no significant difference between the c-statistics of the adjusted CCI and the adjusted mFI-5 models (p = 0.089) or between the adjusted mFI-11 and the adjusted mFI-5 models (p = 0.82). The 3 indices were well correlated (p < 0.01).CONCLUSIONSThe adjusted mFI-5 model predicts 90-day postoperative mortality among brain tumor patients as well as our adjusted CCI and adjusted mFI-11 models. The simplified mFI-5 may be easily integrated into clinical workflows to predict brain tumor surgery outcomes in real time.

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Modified frailty index predicts postoperative outcomes of spontaneous intracerebral hemorrhage

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2018.11.004 ◽

2018 ◽

Vol 175 ◽

pp. 137-143 ◽

Cited By ~ 11

Author(s):

Yukihiro Imaoka ◽

Takayuki Kawano ◽

Akihito Hashiguchi ◽

Kenji Fujimoto ◽

Keizou Yamamoto ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Frailty Index ◽

Postoperative Outcomes ◽

Spontaneous Intracerebral Hemorrhage ◽

Modified Frailty Index

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Association of a Modified Frailty Index with Postoperative Outcomes after Ankle Fractures in Patients Aged 50 Years and Older

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000225 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002 ◽

Cited By ~ 1

Author(s):

Rishin Kadakia ◽

Jason Bariteau ◽

Catphuong Vu ◽

Andrew Pao ◽

Shay Tenenbaum

Keyword(s):

Multivariate Analysis ◽

Postoperative Complications ◽

Assessment Tool ◽

Frailty Index ◽

Reoperation Rate ◽

Ankle Fractures ◽

Postoperative Outcomes ◽

Improvement Project ◽

Modified Frailty Index ◽

Reoperation Rates

Category: Ankle, Trauma Introduction/Purpose: Frailty, a multifaceted syndrome resulting from a decrease in physiologic reserves, has been previously shown to play a significant role in elderly morbidity and mortality. The literature on frailty within orthopaedic surgery is limited currently. No study to date has assessed frailty as a predictor of postoperative outcomes in elderly patients with ankle fractures. We hypothesized that increasing frailty would be associated with increased 30-day reoperation rates and increased postoperative complications. Methods: The National Surgical Quality Improvement Project (NSQIP) was queried using the appropriate CPT codes to identify inpatients from 2005-2014 who were aged 50 years and older that sustained an ankle fracture and underwent operative fixation. Frailty was assessed using a modified frailty index (MFI), abbreviated with 11 variables from the Canadian Study of Health and Aging Frailty Index. The primary outcome was 30-day reoperation rate and secondary outcomes were postoperative surgical and medical complications, readmission rates, and length of stay. Bivariate and multivariate analysis was used to determine association between outcomes and MFI. Results: 6,749 patients were identified, and the mean age of these patients was 64.4 years. Patients with increased MFI scores had significantly higher rates of postoperative complications. In addition, increased MFI scores was also associated with increased 30 day readmissions and reoperations. Multivariate analysis also demonstrated that MFI was a stronger predictor of 30 day reoperation rates (odds ratio of 17.7, P < 0.001) than age, wound class, and ASA class. Conclusion: Frailty has the potential to be an important predictive variable of postoperative outcomes in patients aged 50 years and older who sustain ankle fractures. The modified frailty index can be a valuable preoperative risk assessment tool for the orthopaedic surgeon. Further study is necessary to examine the effect of the MFI in a larger prospective setting.

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Novel bypass risk predictive tool is superior to the 5-Factor Modified Frailty Index in predicting postoperative outcomes

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.11.050 ◽

2020 ◽

Vol 72 (4) ◽

pp. 1427-1435.e1

Author(s):

Zein M. Saadeddin ◽

Jeffrey D. Borrebach ◽

Jacob C. Hodges ◽

Efthymios D. Avgerinos ◽

Michael Singh ◽

...

Keyword(s):

Frailty Index ◽

Postoperative Outcomes ◽

Predictive Tool ◽

Modified Frailty Index

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Frailty: A major consideration for short- and long-term outcomes in resected pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.418 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 418-418

Author(s):

Ioannis Konstantinidis ◽

Aaron G Lewis ◽

Federrico Tozzi ◽

Philip HG Ituarte ◽

Susanne Warner ◽

...

Keyword(s):

Pancreatic Cancer ◽

Frailty Index ◽

Postoperative Mortality ◽

Postoperative Outcome ◽

Postoperative Outcomes ◽

Improvement Program ◽

California Cancer Registry ◽

Modified Frailty Index ◽

Comorbidity Index ◽

Short And Long Term

418 Background: Frailty has been associated with adverse postoperative outcomes. However, little is known about its correlation with survival in resected pancreatic cancer. This study examined the correlation of frailty with postoperative outcomes and survival after pancreatectomy for cancer. Methods: Data from National Surgical Quality Improvement Program (NSQIP) patients (n = 7400) who underwent pancreatectomy between 2011 to 2013. A modified frailty index (mFI) validated for use in NSQIP was used to examine correlations between frailty and postoperative outcomes. California Cancer Registry (CCR) data for patients (n = 4959) who underwent pancreatectomy for cancer between 2000 to 2012 was used to assess the association between the Charlson Comorbidity Index (CCI), as a surrogate for frailty, and overall survival. Results: The distribution of NSQIP patients according to the mFI was 0, 1, 2, 3, 4 in 2797 (37.8%), 3422 (46.2), 1074 (14.5), 104 (1.4) and 3 (0.04) respectively. The patients were divided to non frail (mFI = 0), mildly frail (mFI = 1-2), or severely frail (mFI3 ≥ 3). Overall, 8.7% of patients experienced a grade 4 Clavien complication and 3.1% experienced postoperative mortality. Worsening frailty correlated with an increase in grade 4 Clavien complications (non-frail: 6.3% vs. mildly frail: 9.7% vs. severely frail: 26.2%; p < 0.001) and mortality (1.9% vs. 3.8% vs. 4.7% respectively; p < 0.001). The majority of CCR patients had similarly few comorbidities: CCI: 0, 1, ≥ 2 in 3869 (77.8%), 861 (17.31%) and 243 (4.89%) respectively. Median survival decreased as CCI increased (for CCI 0, 1 and ≥ 2 was 23 vs. 19 vs. 15 months respectively; p < 0.001). Conclusions: Frailty is a powerful correlate of postoperative outcome and survival for resected pancreatic cancer patients and is an important consideration in planning for surgical intervention.

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Coagulation Alteration and Deep Vein Thrombosis in Brain Tumor Patients During the Perioperative Period

World Neurosurgery ◽

10.1016/j.wneu.2018.03.128 ◽

2018 ◽

Vol 114 ◽

pp. e982-e991 ◽

Cited By ~ 2

Author(s):

Xiaopeng Guo ◽

Fa Zhang ◽

Yue Wu ◽

Lu Gao ◽

Qiang Wang ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Brain Tumor ◽

Perioperative Period ◽

Tumor Patients ◽

Vein Thrombosis ◽

Deep Vein

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Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients

Journal of Surgical Oncology ◽

10.1002/jso.24617 ◽

2017 ◽

Vol 115 (8) ◽

pp. 997-1003 ◽

Cited By ~ 26

Author(s):

Sarah A. Vermillion ◽

Fang-Chi Hsu ◽

Robert D. Dorrell ◽

Perry Shen ◽

Clancy J. Clark

Keyword(s):

Cancer Patients ◽

Gastrointestinal Cancer ◽

Frailty Index ◽

Postoperative Outcomes ◽

Modified Frailty Index

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Tinzaparin prophylaxis in brain tumor patients

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.12506 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 12506-12506

Author(s):

C. W. Bohlin ◽

D. A. Reardon ◽

A. Desjardins ◽

J. A. Quinn ◽

J. N. Rich ◽

...

Keyword(s):

Brain Tumor ◽

Phase Ii ◽

Factor Xa ◽

Liver Function Tests ◽

Thromboembolic Disease ◽

Phase Iii ◽

Bleeding Complications ◽

Tumor Patients ◽

Vein Thrombosis ◽

Low Incidence

12506 Background: Thromboembolic disease is the second leading cause of death in brain tumor patients. Various studies have documented a 20–40% risk of deep vein thrombosis and / or pulmonary embolus in brain tumor patients. When used as prophylaxis, Tinzaparin, a low molecular weight heparin with factor Xa activity, has a low complication rate and low incidence of bleeding complications. With the anticipated benefit exceeding any risk, prophylaxis with Tinzaparin may be safe and effective. Methods: A phase II trial of prophylactic tinzaparin for newly diagnosed brain tumor patients has completed accrual at 40 patients. A fixed daily dose of 4500 IU subcutaneous tinzaparin was given beginning a minimum of 48 hours post-operatively and a maximum of 4 weeks post-operatively. Patients consented to take tinzaparin daily for 12 months. Weekly blood counts were monitored during chemotherapy cycles. Tinzaparin was held if platelet count was <50,000 and resumed once the platelets were >100,000. Tinzaparin was discontinued in patients who began treatment with avastin. Results: Of 40 patients, 7 remain on treatment. Patients have taken tinzaparin for 4–52 weeks with a median of 21 weeks. One of the patients developed a grade 3 CNS hemorrhage and one had a grade 1 CNS hemorrhage, necessitating cessation of the tinzaparin, there have been no grade 4 or 5 CNS hemorrhages or treatment associated mortality. No patients developed = grade 2 systemic hemorrhages. One patient developed a deep venous thrombosis while taking tinzaparin, and three patients developed thromboembolic complications while off tinzaparin secondary to thrombocytopenia. One patient was taken off study for increased liver function tests, possibly secondary to tinzaparin. Conclusions: Thus far, daily prophylactic tinzaparin has proven safe and effective in decreasing the incidence of thromboembolic disease in brain tumor patients. We plan a phase III study upon the safe completion of the last 7 patients on this phase II study. No significant financial relationships to disclose.

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