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The 5-factor modified frailty index predicts health burden following surgery for pituitary adenomas

Pituitary volume 23, pages 630–640 (2020)Cite this article

Abstract

Purpose

Frailty is known to influence cost-related surgical outcomes in neurosurgery, but quantifying frailty is often challenging. Therefore, we investigated the predictive value of the 5-factor modified frailty index (mFI-5) on total hospital charges, LOS, and 90-day readmission for patients undergoing pituitary surgery.

Methods

The medical records of all patients undergoing endoscopic endonasal resection of pituitary adenomas at an academic medical center between January 2017 and December 2018 were retrospectively reviewed. Bivariate statistical analyses were conducted using Fisher’s exact test, chi-square test, and independent samples t-test. Linear and logistic regression models were used for multivariate analysis.

Results

Our cohort (n = 234) had a mean age of 53.8 years (standard deviation 14.6 years). Sex distributions were equal, and most patients were Caucasian (59%). On multivariate linear regression, with each one-point increase in mFI-5, total LOS increased by 0.64 days in the overall cohort (p < 0.001), 1.08 days in the Cushing disease cohort (p = 0.045), and 0.59 days in non-functioning tumors cohort (p = 0.004). Total charges increased by $3954 in the whole cohort (p < 0.001), $10,652 in the Cushing disease cohort (p = 0.033), and $2902 in the non-functioning tumors cohort (p = 0.007) with each one-point increase in mFI-5. Greater mFI-5 scores were associated with greater odds of 90-day readmission in both overall and Cushing disease cohorts, but these associations did not reach statistical significance.

Conclusion

A patient’s mFI-5 score is significantly associated with increased length of stay and hospital charges for patients undergoing pituitary surgery. The mFI-5 may hold peri-operative value in patient counseling for pituitary adenoma surgery.

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Data availability

Research data and code for statistical analyses are stored in an institutional repository and will be shared upon request to the corresponding author.

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Author information

Affiliations

  1. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA

    Adham M. Khalafallah, Pavan P. Shah, Sakibul Huq, Adrian E. Jimenez, Palak P. Patel, Gary L. Gallia & Debraj Mukherjee

  2. Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA

    Nyall R. London Jr. & Nicholas R. Rowan

  3. Division of Endocrinology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA

    Amir H. Hamrahian & Roberto Salvatori

  4. Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA

    Nyall R. London Jr., Amir H. Hamrahian, Roberto Salvatori, Gary L. Gallia, Nicholas R. Rowan & Debraj Mukherjee

  5. Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA

    Debraj Mukherjee

Authors
  1. Adham M. Khalafallah
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  2. Pavan P. Shah
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Correspondence to Debraj Mukherjee.

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All the authors declared that they have no conflict of interest.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Johns Hopkins University approved this study.

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Our Institutional Review Board (IRB) approved the waiver of informed consent for this single-institution, retrospective, HIPAA-compliant study (IRB number 00209855).

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Cite this article

Khalafallah, A.M., Shah, P.P., Huq, S. et al. The 5-factor modified frailty index predicts health burden following surgery for pituitary adenomas. Pituitary 23, 630–640 (2020). https://doi.org/10.1007/s11102-020-01069-5

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Keywords

  • Frailty
  • mFI-5
  • Comorbidities
  • Pituitary surgery
  • Length of stay
  • Charges