Anterior Skull Base Outcomes and Complications: A Propensity Score Matched Evaluation of Age and Frailty as Measured by MFI-5 from the ACS-NSQIP Database

Background: Frailty is increasingly recognized as a predictive factor of surgical outcomes—however, its utility in anterior cranial fossa (ACF) surgery has not been sufficiently examined.

Objective: Analyze the independent predictive ability of age and frailty in postoperative complications following ACF surgery.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried, by current procedural terminology (CPT) codes, for ACF procedures between 2005 and 2020. A propensity score matched dataset was built and analyzed via multiple linear regression. To achieve more comparable datasets, a nearest-neighbor matching algorithm was performed via the MatchIt package in R. This matching was done with a 1:1 ratio, matching with equal ratios of CPT codes, and by the length of operation. Length of operation was chosen as a proxy for the complexity of a case, which could not be accounted for adequately with other variables included by the NSQIP dataset. Pituitary adenoma (PA) cases were similarly identified and analyzed to serve as an internal comparison.

Results: A total of 1,651 ACF cases, and 2,246 PA cases were identified from the NSQIP database (Table 1 and Table 2). Following matching, the datasets contained 506 ACF cases and 706 PA cases. Unmatched multivariate analysis of ACF cases demonstrated severe frailty (mFI-5 3 and 4) was independently associated with having any complications (OR = 3.67) and minor complications (OR = 5.00; p < 0.001; Table 3). Analysis of individual mFI-5 components demonstrated poor functional status significantly associated with any complications (OR = 3.39), major complication (OR = 3.59), and minor complications (OR = 3.14; p < 0.001). Increasing age was not predictive of complications in ACF or PA cases. However, post-matched multivariate analysis demonstrated age was predictive of minor complications, with an OR of 1.02 per year increase in age, and elongated length of stay (eLOS) (OR = 1.02; p < 0.001; Table 4). Frailty did not maintain its predictive ability post-matching. Non-independent functional status in ACF cases maintained significant predictive ability for any complications (OR = 4.94), major complications (OR = 4.68), minor complications (OR = 4.80), and eLOS (OR = 2.92; p < 0.001).

Conclusions: Following propensity score matching, age demonstrated increased ability to predict postoperative complications in ACF surgery compared with mFI-5. Individual mFI-5 components, such as functional status, indicate potential risk factors which can be optimized prior to surgery for better outcomes.

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Artikel online veröffentlicht:
01. Februar 2023