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RAI-measured frailty predicts non-home discharge following metastatic brain tumor resection: national inpatient sample analysis of 20,185 patients

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Abstract

Purpose

Preoperative risk stratification for patients undergoing metastatic brain tumor resection (MBTR) is based on established tumor-, patient-, and disease-specific risk factors for outcome prognostication. Frailty, or decreased baseline physiologic reserve, is a demonstrated independent risk factor for adverse outcomes following MBTR. The present study sought to assess the impact of frailty, measured by the Risk Analysis Index (RAI), on MBTR outcomes.

Methods

All MBTR were queried from the National Inpatient Sample (NIS) from 2019 to 2020 using diagnosis and procedural codes. The relationship between preoperative RAI frailty score and our primary outcome – non-home discharge (NHD) – and secondary outcomes – complication rates, extended length of stay (eLOS), and mortality – were analyzed via univariate and multivariable analyses. Discriminatory accuracy was tested by computation of concordance statistics in area under the receiver operating characteristic (AUROC) curve analysis.

Results

There were 20,185 MBTR patients from the NIS database from 2019 to 2020. Each patient’s frailty status was stratified by RAI score: 0–20 (robust): 34%, 21–30 (normal): 35.1%, 31–40 (very frail): 13.9%, 41+ (severely frail): 16.8%. Compared to robust patients, severely frail patients demonstrated increased complication rates (12.2% vs. 6.8%, p < 0.001), eLOS (37.6% vs. 13.2%, p < 0.001), NHD (52.0% vs. 20.6%, p < 0.001), and mortality (9.9% vs. 4.1%, p < 0.001). AUROC curve analysis demonstrated good discriminatory accuracy of RAI-measured frailty in predicting NHD after MBTR (C-statistic = 0.67).

Conclusion

Increasing RAI-measured frailty status is significantly associated with increased complication rates, eLOS, NHD, and mortality following MBTR. Preoperative frailty assessment using the RAI may aid in preoperative surgical planning and risk stratification for patient selection.

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The authors did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. School of Medicine, Georgetown University, Washington, District of Columbia, USA

    Michael M. Covell

  2. New Jersey Medical School, Newark, New Jersey, USA

    Akshay Warrier

  3. Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA

    Kranti C. Rumalla

  4. Bowdoin College, Brunswick, Maine, USA

    Christopher M. Dehney

  5. Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, Utah, 84070, USA

    Christian A. Bowers

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Contributions

M.C. wrote the manuscript draft, revised the manuscript draft, and managed the project. A.W. wrote the manuscript draft. K.R. performed the statistical analyses, prepared Fig. 1, and prepared Tables 1, 2 and 3. C.D. wrote the manuscript draft. C.B. wrote the manuscript draft, revised the manuscript draft, and provided study supervision. All authors reviewed the manuscript prior to submission.

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Correspondence to Christian A. Bowers.

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Covell, M.M., Warrier, A., Rumalla, K.C. et al. RAI-measured frailty predicts non-home discharge following metastatic brain tumor resection: national inpatient sample analysis of 20,185 patients. J Neurooncol 164, 663–670 (2023). https://doi.org/10.1007/s11060-023-04461-w

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