REVIEW   

Journal of Neurosurgical Sciences 2024 April;68(2):208-15

DOI: 10.23736/S0390-5616.23.06130-1

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

Frailty as a predictor of postoperative outcomes in neurosurgery: a systematic review

Joanna M. ROY ^{1, 2}, Syed F. KAZIM ^{2, 3}, Dylan MACCIOLA ⁴, Dante N. RANGEL ⁵, Kavelin RUMALLA ^{2, 3}, Zafar KARIMOV ⁴, Remy LINK ⁵, Javed IQBAL ^{2, 3}, Muhammad A. RIAZ ³, Georgios P. SKANDALAKIS ^{2, 3}, Carmelo V. VENERO ⁶, Rachel B. SIDEBOTTOM ⁵, Alis J. DICPINIGAITIS ⁵, Christian S. KASSICIEH ⁷, Omar TARAWNEH ^{2, 4}, Matt S. CONLON ^{2, 4}, Rachel THOMMEN ^{2, 4}, Daniel J. ALVAREZ-CRESPO ⁸, Karizma CHHABRA ⁴, Sahaana SRIDHAR ⁷, Amanpreet GILL ⁷, John VELLEK ⁴, Phuong A. NGUYEN ⁵, Grace THOMPSON ⁵, Myranda ROBINSON ⁵, Christian A. BOWERS ^{2, 3} ✉

¹ Topiwala National Medical College, Mumbai, India; ² Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA; ³ Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA; ⁴ School of Medicine, New York Medical College, Valhalla, NY, USA; ⁵ School of Medicine, University of New Mexico, Albuquerque, NM, USA; ⁶ School of Medicine, University of Kentucky, Lexington, KY, USA; ⁷ Burrell College of Osteopathic Medicine, Las Cruces, NM, USA; ⁸ School of Medicine, University of Panama, Panama City, Panama

INTRODUCTION: Baseline frailty status has been utilized to predict a wide range of outcomes and guide preoperative decision making in neurosurgery. This systematic review aims to analyze existing literature on the utilization of frailty as a predictor of neurosurgical outcomes.
EVIDENCE ACQUISITION: We conducted a systematic review following PRISMA guidelines. Studies that utilized baseline frailty status to predict outcomes after a neurosurgical intervention were included in this systematic review. Studies that utilized sarcopenia as the sole measure of frailty were excluded. PubMed, EMBASE, and Cochrane library was searched from inception to March 1^st, 2023, to identify relevant articles.
EVIDENCE SYNTHESIS: Overall, 244 studies met the inclusion criteria. The 11-factor modified frailty index (mFI-11) was the most utilized frailty measure (N.=91, 37.2%) followed by the five-factor modified Frailty Index (mFI-5) (N.=80, 32.7%). Spine surgery was the most common subspecialty (N.=131, 53.7%), followed by intracranial tumor resection (N.=57, 23.3%), and post-operative complications were the most reported outcome (N.=130, 53.2%) in neurosurgical frailty studies. The USA and the Bowers author group published the greatest number of articles within the study period (N.=176, 72.1% and N.=37, 15.2%, respectively).
CONCLUSIONS: Frailty literature has grown exponentially over the years and has been incorporated into neurosurgical decision making. Although a wide range of frailty indices exist, their utility may vary according to their ability to be incorporated in the outpatient clinical setting.

KEY WORDS: Decision making; Frailty; Neurosurgery