AOS035 - Association of Baseline Frailty Status and Age with Postoperative Complications following Cochlear Implantation: A National Inpatient Sample Study
Saturday, April 30, 2022
10:24 AM – 10:31 AM CT
Location: Landmark A
Kyril L. Cole, MPH
Alis J. Dicpinigaitis, BA
Eric Babajanian, MD
Steven A. Gordon MD MPH
Neil S. Patel, MD
Christian A. Bowers, MD
Richard K. Gurgel, MD, MSCI
Objective: To determine the independent associations of chronological age and frailty, as measured by a validated, 5- factor modified frailty index (mFI-5 respectively), on postoperative outcomes of patients undergoing cochlear implantation (CI).
Study Design: Cross-sectional national database study
Setting:National Inpatient Sample Database
Patients: Adult patients undergoing CI surgery from 2001-2018.
Interventions: Cochlear implantation. In addition to demographics and postoperative complications, the mFI-5 (comprising a pre-operative history of chronic obstructive pulmonary disease, congestive heart failure, hypertension, diabetes mellitus, and partial or total-dependent functional status) was calculated for all patients included in the analysis.
Main Outcome Measures: Any postoperative complications, including major complications (pneumonia, sepsis, etc.), minor complications (urinary tract infections, blood transfusions, etc.), and implant-specific complications (otitis media, implant failure, etc.). Predictors of complications were examined using multivariate logistic regression with an odds ratio (OR) and a 95% confidence interval (95% CI) reported.
Results: There were 5,130 patients included with a median age of 60 (interquartile range 44-73) and a female predominance (53.5%). There were 2,979 (58.1%) robust patients (non-frail, mFI-5=0), 1,710 (33.3%) pre-frail (mF-5=1), 362 (7.1%) frail (mFI-5=2), and 78 (1.5%) severely-frail (mFI-5>3). There were 328 (6.5%) patients who experienced postoperative complications. Multivariate analysis showed no statistically significant correlation between patient age and complications, however, increasing frailty did show an independent correlation with non-home discharge (severely frail, OR 16.99, 95% CI 10.36-27.90, p < 0.001).
Conclusions: Increasing frailty and age do not predispose to postoperative complications in this patient cohort. However, frail patients are at increased risk for non-home discharge.
*Professional Practice Gap & Educational Need: Patients and clinicians may believe that older patients should not be considered for CI due to risks of surgery. Many studies have been devoted to the safety of CI in older adults, though few report on an accurate metric to account for medical comorbidities, i.e., frailty, and how frailty may impact the postoperative course of CI patients. This study suggests that CI is low risk at the ages studied, but patients with increasing frailty may require more intensive postoperative monitoring for discharge to home.
*Learning Objective: Understanding frailty’s predictive ability on postoperative complications following CI.
*Desired Result: To provide a metric that can risk stratify adult CI patients for postoperative complications or non-home discharge.
Level of Evidence - Level III
Indicate IRB or IACUC: University of Utah IRB_00147585