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<p>Frailty is increasingly recognized as a major determinant of surgical risk in older adults; however, its prognostic significance in the context of elective neurosurgery remains unclear. This study investigated the prevalence of frailty, the concordance between three validated frailty instruments, and their association with postoperative complications. A prospective cohort study was conducted at a tertiary neurosurgical center from November&#xa0;2021 to November&#xa0;2024. Patients aged ≥ 65&#xa0;years undergoing elective cranial or spinal surgery were included. Preoperative frailty was assessed using the Clinical Frailty Scale (CFS), the Comprehensive Geriatric Assessment Frailty Index (CGA-FI), and the Fried’s Frailty Phenotype (FFP) criteria. Postoperative complications—including infectious, cardiovascular, neurological, haemorrhagic events, delirium, and in-hospital death—were systematically recorded. Associations with frailty were examined using multivariable logistic regression adjusted for covariates. Among 181 patients (mean age, 74.1 [SD] 6.1&#xa0;years), frailty prevalence ranged from 23.8% (CGA-FI) to 44.2% (FFP). Agreement between instruments was variable, with substantial concordance between CFS and CGA-FI (<i>κ</i> = 0.65) and only moderate concordance with FFP. Postoperative complications occurred in 47 (25.9%) patients. Frailty defined by CFS (adjusted odds ratio [aOR], 2.73; 95% CI, 1.05–7.42) and CGA-FI (aOR, 3.78; 95% CI, 1.34–11.1) was independently associated with increased risk of complications. In conclusion,&#xa0;frailty as assessed by the CFS and CGA-FI, is a strong determinant of postoperative risk in older adults undergoing elective neurosurgery. Incorporating frailty assessment into routine neurosurgical pathways may improve perioperative risk stratification and guide clinical decision-making.</p>

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Frailty and postoperative risk in geriatric neurosurgery: a prospective cohort study using multidimensional assessment

  • 期刊论文

  • 发表日期：

    2026年1月7日

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  • Chukwuma Okoye,
  • Valentina Stella,
  • Louis-Georges Roumy,
  • Chiara Benedetta Rui,
  • Alice Margherita Ornago,
  • Paola Signorelli,
  • Benedetta Maisano,
  • Beatrice Tonus,
  • Alberto Finazzi,
  • Maria Cristina Ferrara,
  • Elena Pinardi,
  • Carlo Giorgio Giussani,
  • Giuseppe Bellelli

摘要

Frailty is increasingly recognized as a major determinant of surgical risk in older adults; however, its prognostic significance in the context of elective neurosurgery remains unclear. This study investigated the prevalence of frailty, the concordance between three validated frailty instruments, and their association with postoperative complications. A prospective cohort study was conducted at a tertiary neurosurgical center from November 2021 to November 2024. Patients aged ≥ 65 years undergoing elective cranial or spinal surgery were included. Preoperative frailty was assessed using the Clinical Frailty Scale (CFS), the Comprehensive Geriatric Assessment Frailty Index (CGA-FI), and the Fried’s Frailty Phenotype (FFP) criteria. Postoperative complications—including infectious, cardiovascular, neurological, haemorrhagic events, delirium, and in-hospital death—were systematically recorded. Associations with frailty were examined using multivariable logistic regression adjusted for covariates. Among 181 patients (mean age, 74.1 [SD] 6.1 years), frailty prevalence ranged from 23.8% (CGA-FI) to 44.2% (FFP). Agreement between instruments was variable, with substantial concordance between CFS and CGA-FI (κ = 0.65) and only moderate concordance with FFP. Postoperative complications occurred in 47 (25.9%) patients. Frailty defined by CFS (adjusted odds ratio [aOR], 2.73; 95% CI, 1.05–7.42) and CGA-FI (aOR, 3.78; 95% CI, 1.34–11.1) was independently associated with increased risk of complications. In conclusion, frailty as assessed by the CFS and CGA-FI, is a strong determinant of postoperative risk in older adults undergoing elective neurosurgery. Incorporating frailty assessment into routine neurosurgical pathways may improve perioperative risk stratification and guide clinical decision-making.