Frailty Is Associated with In-hospital Morbidity and Non-routine Disposition in Brain Tumor Patients Undergoing Craniotomy.

PURPOSE Frailty is associated with postoperative morbidity in multiple surgical disciplines. We sought to evaluate the association between frailty and early postoperative outcomes for brain tumor patients in a national database. METHODS We reviewed the Nationwide Readmissions Database from 2010-2014. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to identify benign and malignant brain tumors treated with surgical resection. Pituitary tumors were excluded. Frailty was assessed using the Johns Hopkins Adjusted Clinical Groups frailty indicator tool. Multivariable exact logistic regression was used to conduct analyses assessing the association between frailty and outcome variables. Statistical significance was defined as p<0.001. RESULTS Criteria for frailty were met in 7,209 of 87,835 (8.2%) of patients. After adjustment for patient and hospital factors, frailty was independently associated with in-hospital surgical complications (OR 1.48, 95% CI 1.37 - 1.59, p<0.0001), mental status changes (OR 1.9, 95% CI 1.72 - 2.09, p<0.0001), and pulmonary insufficiency (OR 1.75, 95% CI 1.55 - 1.96, p<0.0001). Frailty was associated with increased length of stay (incident rate ratio 1.92, 95% CI 1.87 - 1.98, p<0.0001) and non-routine disposition (OR 1.84, 95% CI 1.72 - 1.97, p<0.0001). In-hospital mortality was higher in frail patients (2.2% vs. 1.4%, P<0.0001), but this did not achieve significance on multivariate analysis. Frail patients were not more likely to be readmitted. CONCLUSION Frailty is associated with in-hospital complications and non-routine disposition after craniotomy for benign and malignant brain tumors. Additional work is needed to identify prehabilitation or in-hospital strategies to improve care of these at-risk patients.