Modified Frailty Index-11 (mFI-11) Measured Frailty as a Predictor of Postoperative Outcomes in Parkinson's Disease Patients Undergoing Deep Brain Stimulation: A National Inpatient Sample Analysis
Kaitlyn Heintzelman1, David Fletcher1, Abdul Khan4, Umesh Ananthasayanam5, Peter Konrad2, Adeel Memon3
1School of Medicine, 2Department of Neurosurgery, 3Department of Neurology, West Virginia University, 4Department of Medicine, Jinnah Sindh Medical University, 5Department of Medicine, Kursk State Medical University
Objective:

Use frailty as a predictor of postoperative outcomes in Parkinson’s Disease (PD) patients undergoing deep brain stimulation (DBS) using the Nationwide Inpatient Sample (NIS).

Background:
PD presents with tremor, rigidity, bradykinesia, and postural instability. Commonly, PD is diagnosed around age 60 with the rate of diagnosis increasing with age. DBS is an invasive surgical treatment for PD. Inherently, older patients are more frail than younger patients and may experience more negative outcomes with DBS.
Design/Methods:

This retrospective cohort study analyzed NIS data from 2016-2020, identifying PD patients who received DBS. Frailty was determined using the 11-item mFI-11, with patients classified into frail and non-frail groups. Primary outcomes included prolonged length of stay (LOS) beyond the 75th percentile, non-routine discharge, and postoperative complications. Secondary outcomes involved total hospital costs. Univariate and multivariate analyses were performed, adjusting for demographics, comorbidities (CCI), and hospital characteristics.

Results:

A total of 3,545 patients met the inclusion criteria. Frailty was associated with significantly higher odds of unfavorable discharge (aOR: 1.80, 95% CI: 1.47–2.20, p < 0.001), prolonged LOS (aOR: 2.01, 95% CI: 1.59–2.57, p < 0.001), and postoperative complications (OR: 1.57, 95% CI: 1.45–1.70, p < 0.001). In the lower CCI group, frailty was significantly associated with both prolonged LOS (aOR: 1.63, 95% CI: 1.25–2.13) and non-routine discharge (aOR: 1.47, 95% CI: 1.18–1.84). Among patients with higher CCI scores, frail patients also had increased odds of unfavorable outcomes, though less pronounced. Frailty was linked to an additional $6,588 in hospital costs (p = 0.004).

Conclusions:

Frailty is a strong predictor of adverse outcomes in PD patients undergoing DBS, including prolonged LOS, non-routine discharge, and postoperative complications. These findings suggest that incorporating frailty assessments into preoperative planning may improve outcomes and reduce healthcare costs.

10.1212/WNL.0000000000210848
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