• Collin B Kilgore, Anita L Kalluri, Sumil K Nair, Kyra M Halbert-Elliot, Emeka Ejimogu, Bryan Dong, Sachiv Chakravarti, Mostafa W Abdulrahim, Christopher M Jackson, Michael Lim, Judy Huang, Chetan Bettegowda, and Risheng Xu.
• Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Medical Scientist Training Program, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
• World Neurosurg. 2023 Dec 1; 180: e700e705e700-e705.

BackgroundTrigeminal neuralgia (TN) is a debilitating orofacial pain disorder. Recent data from a national database suggest that microvascular decompression (MVD) in frail patients is associated with more postoperative complications. However, the long-term pain outcomes for frail TN patients are not known. We aimed to elucidate the relationship between frailty and long-term pain outcomes after MVD for TN.MethodsFrom 2007 to 2020, 368 TN patients aged ≥60 years underwent MVD at our institution. Patient demographics, clinical characteristics, postoperative complications, and long-term pain outcomes were recorded. Frailty was assessed using the modified 5-item frailty index (mFI-5) score, and the patients were dichotomized into nonfrail (mFI-5 <2) and frail (mFI-5 >1). Differences were assessed via the t test, χ2 test, multivariate ordinal regression, and Cox proportional hazards analysis.ResultsOf the 368 patients analyzed, 9.8% were frail. The frail patients were significantly older (P = 0.02) with a higher body mass index (P = 0.01) and a greater incidence of comorbidities (P < 0.001). Frail patients presented with significantly higher pain levels at the final follow-up (P = 0.04). On multivariate analysis, frailty was independently associated with more pain at follow-up (P = 0.01), as was younger age, female sex, and black race. The relationship between frailty and postoperative pain recurrence showed a trend toward significance (P = 0.06), and younger age and black race were significantly associated with recurrence.ConclusionsFrail patients undergoing MVD are at risk of worse long-term pain outcomes. Our results provide clinicians with useful information pertaining to the influence of frailty on the long-term efficacy of MVD in treating TN.Copyright © 2023 Elsevier Inc. All rights reserved.

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