학술논문
Frailty Is Superior to Age for Predicting Readmission, Prolonged Length of Stay, and Wound Infection in Elective Otology Procedures.
Document Type
Academic Journal
Author
Stidham K; Department of Otolaryngology, Westchester Medical Center.; Naftchi AF; School of Medicine, New York Medical College.; Spirollari E; School of Medicine, New York Medical College.; Vaserman G; School of Medicine, New York Medical College.; Vazquez S; School of Medicine, New York Medical College.; Das A; School of Medicine, New York Medical College.; Colasacco C; School of Medicine, New York Medical College.; Culbertson S; School of Medicine, New York Medical College.; Ng C; School of Medicine, New York Medical College.; Graifman G; School of Medicine, New York Medical College.; Beaudreault C; School of Medicine, New York Medical College.; Lui AK; School of Medicine, New York Medical College.; Dominguez JF; Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, New York.; Kazim SF; Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico.; Schmidt M; Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico.; Bowers CA; Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico.
Source
Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 100961504 Publication Model: Print Cited Medium: Internet ISSN: 1537-4505 (Electronic) Linking ISSN: 15317129 NLM ISO Abbreviation: Otol Neurotol Subsets: MEDLINE
Subject
Language
English
Abstract
Objective: To determine the predictive ability of the 5-point modified frailty index relative to age in elective otology patients.
Study Design: Retrospective database analysis.
Setting: Multicenter, national database of surgical patients.
Patients: We selected all elective surgical patients who received tympanoplasty, tympanomastoidectomy, mastoidectomy, revision mastoidectomy, and cochlear implant procedures from 2016 to 2019 from the National Surgical Quality Improvement database.
Interventions: Therapeutic.
Main Outcome Measures: Readmission rates, discharge disposition, reoperation rates, and extended length of hospital stay.
Results: Utilizing receiver operating characteristics with area under the curve (AUC) analysis, nonrobust status was determined to be a superior predictor relative to age of readmission (AUC = 0.628 [p < 0.001] versus AUC = 0.567 [p = 0.047], respectively) and open wound infection relative to age (AUC = 0.636 [p = 0.024] versus AUC = 0.619 [p = 0.048], respectively). Nonrobust otology patients were more likely to have dyspnea at rest and an American Society of Anesthesiology score higher than 2 before surgery (odds ratios, 13.304 [95% confidence interval, 2.947-60.056; p < 0.001] and 7.841 [95% confidence interval, 7.064-8.704; p < 0.001], respectively).
Conclusion: Nonrobust status was found to be a useful predictor of readmission and prolonged length of stay in patients undergoing elective otology procedures, which generally have low complication rate. Given the aging population and corresponding increase in otology disease, it is important to use age-independent risk stratification measures. Frailty may provide a useful risk stratification tool to select surgical candidates within the aging population.
Competing Interests: The authors disclose no conflicts of interest.
(Copyright © 2022, Otology & Neurotology, Inc.)
Study Design: Retrospective database analysis.
Setting: Multicenter, national database of surgical patients.
Patients: We selected all elective surgical patients who received tympanoplasty, tympanomastoidectomy, mastoidectomy, revision mastoidectomy, and cochlear implant procedures from 2016 to 2019 from the National Surgical Quality Improvement database.
Interventions: Therapeutic.
Main Outcome Measures: Readmission rates, discharge disposition, reoperation rates, and extended length of hospital stay.
Results: Utilizing receiver operating characteristics with area under the curve (AUC) analysis, nonrobust status was determined to be a superior predictor relative to age of readmission (AUC = 0.628 [p < 0.001] versus AUC = 0.567 [p = 0.047], respectively) and open wound infection relative to age (AUC = 0.636 [p = 0.024] versus AUC = 0.619 [p = 0.048], respectively). Nonrobust otology patients were more likely to have dyspnea at rest and an American Society of Anesthesiology score higher than 2 before surgery (odds ratios, 13.304 [95% confidence interval, 2.947-60.056; p < 0.001] and 7.841 [95% confidence interval, 7.064-8.704; p < 0.001], respectively).
Conclusion: Nonrobust status was found to be a useful predictor of readmission and prolonged length of stay in patients undergoing elective otology procedures, which generally have low complication rate. Given the aging population and corresponding increase in otology disease, it is important to use age-independent risk stratification measures. Frailty may provide a useful risk stratification tool to select surgical candidates within the aging population.
Competing Interests: The authors disclose no conflicts of interest.
(Copyright © 2022, Otology & Neurotology, Inc.)