Impact of Frailty on Outcomes after Surgery in Patients with Cushing’s Disease: Findings from the Multicenter Rapid Registry

Objective: Attention to the impact of patient frailty on patient outcomes has grown in neuro-oncology due to longer patient survival after diagnosis, improved surgical treatments, and its relationship to postoperative outcomes. The role of frailty in Cushing’s disease (CD) surgical outcomes remains unclear and we sought to evaluate the impact of frailty using the multicenter Registry of Adenomas of the Pituitary and Related Disorders (RAPID) dataset.

Methods: RAPID is a collaboration between United States academic pituitary centers. Consecutive surgically treated CD patients from 2011 to 2023 were analyzed using a modified 11-factor frailty index. Patients were divided into fit (score 1), managing well (score 2–3), and mildly frail (score 4–5).

Results: Frailty was recorded in 318 patients from six centers of which 193 were fit, 113 were managing well and 12 were mildly frail. Mildly frail patients were older on average (39.7 ± 14.2 vs. 48.9 ± 12.2 vs. 49.4 ± 8.9 years, p < 0.001) but otherwise showed no difference in gender, race, or between institutions (p > 0.05). Length of stay was higher for mildly frail patients (3.7 ± 2.0 vs. 4.5 ± 3.5 vs. 5.3 ± 3.5 days, p = 0.02) and this significance persisted (β = 1.01, p = 0.007) after multivariate analysis adjusting for known predictors of prolonged hospitalization such as age, Knosp grade, surgeon experience, ASA score, complications and frailty. Additionally, mildly frail patients were more commonly discharged to skilled nursing facilities (0.5 vs. 5% vs. 25%, p < 0.001). Most patients underwent a gross total resection with no differences between patient groups (84.4 vs. 79.6% vs. 83.3%, p > 0.05). No significant difference in overall complications were seen (p = 0.34) however venous thromboembolism was more common in mildly frail patients (n = 1, 8.3%) compared with well (n = 1, 0.5%) or managing well (n = 3, 2.7%) patients (p = 0.04). No differences in 90-day readmission rates were seen (p = 0.59).

Conclusion: This multicenter study demonstrates that mild frailty independently predicts outcomes after transsphenoidal surgery for Cushing’s disease and may hold value for preoperative risk stratification and prognostication. Frailty impacted CD patient outcomes beyond simply age or tumor characteristics and may be useful for patient prognostication. Further studies can help identify strategies to reduce disease burden for those with hypercortisolemia and high levels of frailty ([Figs. 1] and [2]).

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Artikel online veröffentlicht:
05. Februar 2024