J Neurol Surg B Skull Base 2021; 82(S 02): S65-S270
DOI: 10.1055/s-0041-1725269
Presentation Abstracts
Live Session Abstracts

Utility of Modified Frailty Index (MFI) and Traditional Prognostic Measures to Prognosticate Adverse 30-Day Quality Outcomes after Microvascular Decompression for Trigeminal Neuralgia

Mohammed Ali Alvi
1   Mayo Clinic, Rochester, United States
,
Ronan J. Doherty
2   School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
,
Yagiz U. Yolcu
1   Mayo Clinic, Rochester, United States
,
Alexander Y. Alexander
1   Mayo Clinic, Rochester, United States
,
Panagiotis Kerezoudis
1   Mayo Clinic, Rochester, United States
,
Desmond Brown
1   Mayo Clinic, Rochester, United States
,
Vijay Agarwal
3   Montefiore Medical Center, New York, United States
,
Zoher Ghoghawala
4   Lahey Hospital and Medical Center, Burlington, Massachusetts, United States
,
Michael J. Link
1   Mayo Clinic, Rochester, United States
,
Jamie J. Van Gompel
1   Mayo Clinic, Rochester, United States
,
Frederick B. Meyer
1   Mayo Clinic, Rochester, United States
› Author Affiliations
 

Background: Microvascular decompression (MVD) is an effective neurosurgical intervention for trigeminal neuralgia in patients whose pain is refractory to medical therapy. In this study, we utilized a national surgical-quality registry to analyze the incidence and drivers of 30-day adverse outcomes in patients following MVD and examine the utility of the 5-item modified frailty index (5i-mFI) in predicting these outcomes.

Methods: The National Surgical Quality Improvement Program (NSQIP) database was used to identify patients with trigeminal neuralgia who underwent a suboccipital MVD between 2005 and 2018. Multivariable logistic regressions and receiver operator characteristic (ROC) analyses then assessed the association and predictive capabilities of common metrics on 30-day outcomes. These metrics included age, American Society of Anaesthesiology (ASA) score, body mass index, presence of diabetes, and operative time.

Results: We identified 1,015 patients who underwent MVD for trigeminal neuralgia between 2005 and 2018. On multivariable analysis, adjusting for patient related and clinical factors, a high ASA (3 or 4) was associated with higher odds of complications (OR: 2.71; 95% CI: 1.32–5.55; p = 0.006). For prolonged length of stay, a high ASA score was also implicated (OR: 1.54; 95% CI: 1.09–2.17; p = 0.014), as was an increased operative time (OR: 1.84; 95% CI: 1.31–2.61; p < 0.001). Patients over the age of 65 were at significant risk for non-routine discharge (OR: 3.07; 95% CI: 1.08–8.7; p = 0.02). Significant associations for 30-day readmission included a high ASA score (OR: 1.85; 95% CI: 1.05–3.27; p = 0.034) and male sex (OR: 1.79; 95% CI: 1.06–3.02; p = 0.028). The most common reasons for 30-day readmission were CSF leak (23.2%, n = 16) and surgical site infection (20.3%, n = 14). An increased BMI was a significant risk factor for 30-day reoperation (OR: 1.68; 95% CI: 1.13–2.51; p = 0.011). There were no significant associations with the 5i-mFI for any outcome; however, the area under the ROC curve (AUC) values were comparable with those of the ASA score on ROC analysis. For minor complications, ASA was more predictive than 5i-mFI with AOC values of 0.599 and 0.585, respectively. For major complications, ASA was more predictive than 5i-mFI with AUC values of 0.689 and 0.628, respectively. For any complication, however, 5i-mFI had the strongest AUC value at 0.595. For prolonged length of stay, ASA was most predictive with an AUC value of .568, followed by increased operative time with an AUC value of 0.558, which was followed by 5i-mFI with an AUC value of 0.549. For non-routine discharge, age had the strongest AUC value at 0.678, ASA had the second strongest AUC value of 0.641, and 5i-mFI had the third strongest AUC value at 0.634. For 30-day readmission, 5i-mFI had the strongest AUC value at 0.585 followed by ASA with an AUC value of 0.582. For 30-day reoperation, 5i-mFI had the strongest AUC value at 0.591 while ASA had the weakest AUC value at 0.513.

Conclusion: Our analyses indicate that a higher ASA score, operative time, age and BMI, as well as male sex may be associated with adverse 30-day outcomes among patients undergoing MVD for trigeminal neuralgia.

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Publication History

Article published online:
12 February 2021

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