The utility of the 5-Item frailty index in assessing the risk of complications and mortality following surgical management of non-traumatic subarachnoid hemorrhage

Abstract

The modified 5-item frailty index (mFI-5), an index of reduced physiological reserve, has risen as a predictor of complications following surgical procedures. We examined the association of mFI-5 and surgical outcomes following the management of nontraumatic subarachnoid hemorrhage (nSAH). We queried the American College of Surgeons National Surgical Quality Improvement Program database for patients who received surgical management of nSAH between 2006 and 2021. We computed the mFI-5 by granting a point for each of 1) congestive heart failure, 2) hypertension requiring medications, 3) diabetes, 4) chronic obstructive pulmonary disease or pneumonia within 30 days before surgery, and 5) dependent functional status. Our 30-day endpoints were minor complications (Clavien-Dindo: 1 & 2), major complications (Clavien-Dindo: 3 & 4), and mortality. Using the Chi-squared test, we compared baseline patient demographics and comorbidities between patients with a mFI-5 ≥ 2, patients with a mFI-5 = 1, and non-frail patients. Then, we fitted a multivariable logistic regression adjusting for patient demographics, comorbidities, operative time, and frailty status. The cohort included 1,139 patients, of which 33.7 % were men and 2.9 % had a bleeding diathesis. After adjusting for covariates, mFI-5 ≥ 2 was independently associated with minor complications (1.93, 95 %CI: 1.31–2.84, p = 0.001), major complications (aOR: 1.62, 95 %CI: 1.10–2.37, p = 0.015), and mortality (aOR: 2.90, 95 %CI: 1.66–5.08, p = 0.003). The mFI-5 can be independently used by surgeons for risk stratification and postoperative planning.