• Aladine A Elsamadicy, Mani Ratnesh S Sandhu, Isaac G Freedman, Andrew B Koo, Benjamin C Reeves, James Yu, Astrid Hengartner, John Havlik, Christopher S Hong, RutherfordHelena J VHJVYale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA., Jennifer A Kim, Jason Gerrard, Emily J Gilmore, and Sacit Bulent Omay.
• Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
• World Neurosurg. 2022 Jun 1; 162: e251-e263.

ObjectiveTo determine whether baseline frailty is an independent predictor of extended hospital length of stay (LOS), nonroutine discharge, and in-hospital mortality after evacuation of an acute traumatic subdural hematoma (SDH).MethodsA retrospective cohort study was performed. All adult patients who underwent surgery for an acute traumatic SDH were identified using the National Trauma Database from the year 2017. Patients were categorized into 3 cohorts based on the criteria of the 5-item modified frailty index (mFI-5): mFI = 0, mFI = 1, or mFI = 2+. A multivariate logistic regression analysis was used to identify independent predictors of extended LOS, nonroutine discharge, and in-hospital mortality.ResultsOf the 2620 patients identified, 41.7% were classified as mFI = 0, 32.7% as mFI = 1, and 25.6% as mFI = 2+. Rates of extended LOS and in-hospital mortality did differ significantly between the cohorts, with the mFI = 0 cohort most often experiencing a prolonged LOS (mFI = 0: 29.41% vs. mFI = 1: 19.45% vs. mFI = 2+: 19.73%, P < 0.001) and in-hospital mortality (mFI = 0: 24.66% vs. mFI = 1: 18.11% vs. mFI = 2+: 21.58%, P = 0.002). On multivariate regression analysis, when compared with mFI = 0, mFI = 2+ (odds ratio 1.4, P = 0.03) predicted extended LOS and nonroutine discharge (odds ratio 1.61, P = 0.001).ConclusionsOur study demonstrates that baseline frailty may be an independent predictor of extended LOS and nonroutine discharge, but not in-hospital mortality, in patients undergoing evacuation for an acute traumatic SDH. Further investigations are warranted as they may guide treatment plans and reduce health care expenditures for frail patients with SDH.Copyright © 2022 Elsevier Inc. All rights reserved.

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