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Assessment of the Impact of Frailty on Adverse Surgical Outcomes in Patients Undergoing Surgery for Intracranial Tumors Using Modified Frailty Index: A Systematic Review and Meta-Analysis Publisher Pubmed



Aghajanian S1, 2 ; Shafiee A1, 3 ; Ahmadi A1, 2 ; Elsamadicy AA4
Authors
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Authors Affiliations
  1. 1. Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
  2. 2. Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran
  3. 3. Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States

Source: Journal of Clinical Neuroscience Published:2023


Abstract

Background: Modified frailty index (MFI) is an emerging quantitative measure of frailty; however, the quantified risk of adverse outcomes in surgeries for intracranial tumors associated with increasing MFI scores has not been thoroughly reviewed in a comprehensive manner. Methods: MEDLINE (PubMed), Scopus, Web of Science, and Embase were searched to identify observational studies on the association between 5 and 11 item-modified frailty index (MFI) and perioperative outcomes for neurosurgical procedures including complications, mortality, readmission, and reoperation rate. Primary analysis pooled all comparisons with MFI scores greater than or equal to 1 versus non-frail participants using mixed-effects multilevel model for each outcome. Results: In total, 24 studies were included in the review and 19 studies with 114,707 surgical operations were included in the meta-analysis. While increasing MFI scores were associated with worse prognosis for all included outcomes, reoperation rate was only significantly higher in patients with MFI ≥ 3. Among surgical pathologies, glioblastoma was influenced by a greater extent to the impact of frailty on complications and mortality that most other etiologies. In agreement with qualitative evaluation of the included studies, meta-regression did not reveal association between mean age of the comparisons and complications rate. Conclusion: The results of this meta-analysis provides quantitative risk assessment of adverse outcomes in neuro-oncological surgeries with increased frailty. The majority of literature suggests that MFI is a superior and independent predictor of adverse outcomes compared to age. © 2023 Elsevier Ltd
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