Author(s)
Sofia Olsson, BS
Ashleigh Halderman, MD, FARS
Matthew Ryan, MD, FARS
Bradley Marple, MD
Sei Chung, MD
Affiliation(s)
TCU Burnett School of Medicine; UT Southwestern
Abstract:
Background: Increased frailty has been associated with worse outcomes in various surgical specialties. In endoscopic endonasal skull base surgery (EESBS), the relationship between frailty and postoperative outcomes has been examined to some degree. This scoping review aims to consolidate the current literature analyzing relationships between frailty and EESBS postoperative outcomes.
Methods: A scoping review of frailty in EESBS was conducted on PubMed, Cochrane Library, Ovid Medline, Web of Science, Embase, and Google Scholar. Initial search yielded a total of 408 articles which were reduced using the PRISMA model. Four studies published between 2020 and 2023 fit the inclusion criteria for this review.
Results: A total of 1,306 patients were represented with an average age of 54.1 years. All studies discussed modified frailty index-5 (mFI-5). Two studies analyzed American Society of Anesthesiologists (ASA) classification, and three studies analyzed Charlson comorbidity index (CCI) as additional frailty measures. Higher mFI-5 was associated with prolonged length of stay, increased total hospital charges, worse postoperative quality of life, Clavien-Dindo IV (CDIV) complications, and readmission. Higher ASA was associated with increased rates of CDIV complications, mortality, hemorrhage/hematoma, pneumonia, urinary tract infection, and permanent postoperative diabetes insipidus. CCI was not associated with any of the postoperative complications studied.
Conclusions: Frailty seems to be a valuable predictor of postoperative outcomes following EESBS. However, future studies need to be consistent in which frailty indices are used, and how frailty data is analyzed for effective conclusions to be made.