{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:00:35Z","timestamp":1780736435958,"version":"3.54.1"},"reference-count":84,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>When indicated, patients with symptomatic Chiari malformation type I (CM-I) may benefit from suboccipital decompression (SOD). Although SOD is considered a lower-risk neurosurgical procedure, preoperative risk assessment and careful surgical patient selection remain critical. The objectives of the present study were twofold: 1) describe 30-day SOD outcomes for CM patients with attention to the impact of preoperative frailty and 2) design a predictive model for the primary endpoint of nonhome discharge (NHD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>There were 1015 CM-I patients who underwent SOD in the 2011\u20132020 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, as specified by diagnostic and procedural codes (Current Procedural Terminology code 61343). Descriptive statistics were used to analyze total cohort baseline demographics, preoperative comorbidities, and postoperative outcomes within 30 days of surgery. Univariate cross-tabulation was used to compare baseline demographics and preoperative characteristics across the NHD and home discharge (HD) cohorts. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminative ability of the revised Risk Analysis Index (RAI-rev) on NHD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The study cohort had a median age of 36 years, and 80.6% of patients were female. Race distribution was categorized as White (69.9%), Black (16.6%), and other groups (13.6%). The most common preoperative comorbidities were active smoking (24.4%), hypertension (19.2%), and diabetes mellitus (4.7%). The primary outcome of NHD occurred in 4.6% of patients (n = 47). Increasing frailty (measured by the RAI-rev) was associated with a stepwise increase in the rate of NHD: 2.3% for RAI-rev scores 0\u201310, 5.8% for RAI-rev scores 11\u201315, 7.6% for RAI-rev scores 16\u201320, 18.2% for RAI-rev scores 21\u201325, and 77.8% for RAI-rev scores \u2265 26 (p &lt; 0.001). Other preoperative factors associated with NHD included older age, nonelective surgery, diabetes, hypertension, and elevated creatinine (all p &lt; 0.01). The other most common 30-day complications included unplanned readmission (9.3%), unplanned reoperation (5.3%), return to the operating room (5.8%), Clavien-Dindo grade IV (life-threatening) (1.5%), organ space surgical site infection (SSI) (1.5%), superficial SSI (1.4%), and reoperation for a CSF leak (1.1%). Surgical mortality (within 30 days) was extremely rare (1\/1015, 0.1%). ROC curve analysis demonstrated that RAI-rev predicted NHD with significant discriminatory accuracy among CM-I patients who received SOD treatment (C-statistic 0.731, 95% CI 0.648\u20130.814).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This decade-long analysis of a multicenter surgical registry provides internationally representative, modern rates of 30-day outcomes after suboccipital decompression (with or without duraplasty) for adult CM-I patients. Preoperative frailty assessment with the RAI-rev may help identify higher-risk surgical candidates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2022.12.focus22629","type":"journal-article","created":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T10:07:02Z","timestamp":1677665222000},"page":"E6","source":"Crossref","is-referenced-by-count":7,"title":["Thirty-day outcomes for suboccipital decompression in adults with Chiari malformation type I: a frailty-driven perspective from the American College of Surgeons National Surgical Quality Improvement Program"],"prefix":"10.3171","volume":"54","author":[{"given":"Alexander J.","family":"Kassicieh","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of New Mexico Hospital, Albuquerque;"},{"name":"Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily M.","family":"Estes","sequence":"additional","affiliation":[{"name":"Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico;"},{"name":"Texas Tech University Health Sciences Center School of Medicine, El Paso, Texas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavelin","family":"Rumalla","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of New Mexico Hospital, Albuquerque;"},{"name":"Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Faraz","family":"Kazim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of New Mexico Hospital, Albuquerque;"},{"name":"Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohini G.","family":"McKee","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of New Mexico Hospital, Albuquerque, New Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meic H.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of New Mexico Hospital, Albuquerque;"},{"name":"Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian A.","family":"Bowers","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of New Mexico Hospital, Albuquerque;"},{"name":"Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"J Neurosurg Pediatr","first-page":"217","article-title":"The Chiari I malformation","volume":"24","author":"McClugage SG","year":"2019","unstructured":"McClugage SG, Oakes WJ. The Chiari I malformation. J Neurosurg Pediatr. 2019;24(3):217\u2013226. 31473667"},{"issue":"12","key":"b2","series-title":"Neurol Sci","first-page":"4965","article-title":"The management of Chiari malformation type 1 and syringomyelia in children: a review of the literature","volume":"42","author":"Saletti V","year":"2021","unstructured":"Saletti V, Farinotti M, Peretta P,  The management of Chiari malformation type 1 and syringomyelia in children: a review of the literature. Neurol Sci. 2021;42(12):4965\u20134995. 34591209"},{"issue":"6","key":"b3","series-title":"Radiol Technol","first-page":"555","article-title":"Chiari malformation and syringomyelia","volume":"79","author":"Snyder P","year":"2008","unstructured":"Snyder P. Chiari malformation and syringomyelia. Radiol Technol. 2008;79(6):555\u2013558. 18650532"},{"issue":"3","key":"b4","series-title":"Neurol Res","first-page":"232","article-title":"The pathogenesis of Chiari I malformation and syringomyelia","volume":"33","author":"Sekula RF Jr","year":"2011","unstructured":"Sekula RF Jr, Arnone GD, Crocker C, Aziz KM, Alperin N. The pathogenesis of Chiari I malformation and syringomyelia. Neurol Res. 2011;33(3):232\u2013239. 21513643"},{"issue":"5","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"519","article-title":"Chiari malformation Type I surgery in pediatric patients. Part 1: validation of an ICD-9-CM code search algorithm","volume":"17","author":"Ladner TR","year":"2016","unstructured":"Ladner TR, Greenberg JK, Guerrero N,  Chiari malformation Type I surgery in pediatric patients. Part 1: validation of an ICD-9-CM code search algorithm. J Neurosurg Pediatr. 2016;17(5):519\u2013524. 26799412"},{"key":"b6","series-title":"World Neurosurg","first-page":"213","article-title":"Chiari malformation type 1: a systematic review of natural history and conservative management","volume":"104","author":"Langridge B","year":"2017","unstructured":"Langridge B, Phillips E, Choi D. Chiari malformation type 1: a systematic review of natural history and conservative management. World Neurosurg. 2017;104:213\u2013219. 28435116"},{"issue":"1","key":"b7","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Surgical treatment of Chiari I malformation: indications and approaches","volume":"11","author":"Alden TD","year":"2001","unstructured":"Alden TD, Ojemann JG, Park TS. Surgical treatment of Chiari I malformation: indications and approaches. Neurosurg Focus. 2001;11(1):E2. 16724812"},{"issue":"2","key":"b8","series-title":"Childs Nerv Syst","first-page":"659","article-title":"Chiari I malformation with neurogenic hypertension after suboccipital decompression","volume":"37","author":"Alluhaybi AA","year":"2021","unstructured":"Alluhaybi AA, Abdulqader SB, Alanazi T, Altuhayni K, Albanyan A. Chiari I malformation with neurogenic hypertension after suboccipital decompression. Childs Nerv Syst. 2021;37(2):659\u2013663. 32435888"},{"key":"b9","series-title":"World Neurosurg","first-page":"1057.e9","article-title":"Subdural fluid collection and hydrocephalus after foramen magnum decompression for Chiari malformation type I: management algorithm of a rare complication","volume":"106","author":"Rossini Z","year":"2017","unstructured":"Rossini Z, Milani D, Costa F, Castellani C, Lasio G, Fornari M. Subdural fluid collection and hydrocephalus after foramen magnum decompression for Chiari malformation type I: management algorithm of a rare complication. World Neurosurg. 2017;106:1057.e9\u20131057.e15. 28754644"},{"issue":"3","key":"b10","series-title":"J Craniovertebr Junction Spine","first-page":"169","article-title":"Complication rates following Chiari malformation surgical management for Arnold-Chiari type I based on surgical variables: a national perspective","volume":"11","author":"Passias PG","year":"2020","unstructured":"Passias PG, Naessig S, Para A,  Complication rates following Chiari malformation surgical management for Arnold-Chiari type I based on surgical variables: a national perspective. J Craniovertebr Junction Spine. 2020;11(3):169\u2013172. 33100765"},{"key":"b11","series-title":"World Neurosurg","first-page":"959","article-title":"Preoperative Frailty Score for 30-day morbidity and mortality after cranial neurosurgery","volume":"107","author":"Tomlinson SB","year":"2017","unstructured":"Tomlinson SB, Piper K, Kimmell KT, Vates GE. Preoperative Frailty Score for 30-day morbidity and mortality after cranial neurosurgery. World Neurosurg. 2017;107:959\u2013965. 28736345"},{"issue":"6","key":"b12","series-title":"Am J Cancer Res","first-page":"3294","article-title":"Frailty is associated with mortality in brain tumor patients","volume":"11","author":"Torres-Perez P","year":"2021","unstructured":"Torres-Perez P, \u00c1lvarez-Satta M, Arrazola M,  Frailty is associated with mortality in brain tumor patients. Am J Cancer Res. 2021;11(6):3294\u20133303. 34249463"},{"issue":"4","key":"b13","series-title":"Neurosurg Focus","first-page":"E15","article-title":"The role of frailty in geriatric cranial neurosurgery for primary central nervous system neoplasms","volume":"49","author":"Shahrestani S","year":"2020","unstructured":"Shahrestani S, Lehrich BM, Tafreshi AR,  The role of frailty in geriatric cranial neurosurgery for primary central nervous system neoplasms. Neurosurg Focus. 2020;49(4):E15. 33002865"},{"issue":"1","key":"b14","series-title":"Neurosurg Rev","first-page":"189","article-title":"The immense heterogeneity of frailty in neurosurgery: a systematic literature review","volume":"44","author":"Pazniokas J","year":"2021","unstructured":"Pazniokas J, Gandhi C, Theriault B,  The immense heterogeneity of frailty in neurosurgery: a systematic literature review. Neurosurg Rev. 2021;44(1):189\u2013201. 31953785"},{"key":"b15","series-title":"World Neurosurg","first-page":"e626","article-title":"The Modified 5-Item Frailty Index: a concise and useful tool for assessing the impact of frailty on postoperative morbidity following elective posterior lumbar fusions","volume":"124","author":"Weaver DJ","year":"2019","unstructured":"Weaver DJ, Malik AT, Jain N, Yu E, Kim J, Khan SN. The Modified 5-Item Frailty Index: a concise and useful tool for assessing the impact of frailty on postoperative morbidity following elective posterior lumbar fusions. World Neurosurg. 2019;124:e626\u2013e632."},{"issue":"14","key":"b16","series-title":"Spine (Phila Pa 1976).","first-page":"939","article-title":"The Five-item Modified Frailty Index is predictive of 30-day postoperative complications in patients undergoing spine surgery","volume":"46","author":"Pierce KE","year":"2021","unstructured":"Pierce KE, Naessig S, Kummer N,  The Five-item Modified Frailty Index is predictive of 30-day postoperative complications in patients undergoing spine surgery. Spine (Phila Pa 1976).2021;46(14):939\u2013943. 34160372"},{"issue":"2","key":"b17","series-title":"J Am Coll Surg","first-page":"173","article-title":"New 5-Factor Modified Frailty Index using American College of Surgeons NSQIP data","volume":"226","author":"Subramaniam S","year":"2018","unstructured":"Subramaniam S, Aalberg JJ, Soriano RP, Divino CM. New 5-Factor Modified Frailty Index using American College of Surgeons NSQIP data. J Am Coll Surg. 2018;226(2):173\u2013181.e8. 29155268"},{"issue":"9","key":"b18","series-title":"Am Surg","first-page":"1420","article-title":"The 5-Factor Modified Frailty Index in the geriatric surgical population","volume":"87","author":"Subramaniam S","year":"2021","unstructured":"Subramaniam S, Aalberg JJ, Soriano RP, Divino CM. The 5-Factor Modified Frailty Index in the geriatric surgical population. Am Surg. 2021;87(9):1420\u20131425. 33377791"},{"key":"b19","series-title":"J Surg Res","first-page":"456","article-title":"The 5 and 11 Factor Modified Frailty Indices are equally effective at outcome prediction using TQIP","volume":"255","author":"Tracy BM","year":"2020","unstructured":"Tracy BM, Adams MA, Schenker ML, Gelbard RB. The 5 and 11 Factor Modified Frailty Indices are equally effective at outcome prediction using TQIP. J Surg Res. 2020;255:456\u2013462. 32619861"},{"issue":"2","key":"b20","series-title":"JAMA Surg","first-page":"175","article-title":"Development and initial validation of the Risk Analysis Index for measuring frailty in surgical populations","volume":"152","author":"Hall DE","year":"2017","unstructured":"Hall DE, Arya S, Schmid KK,  Development and initial validation of the Risk Analysis Index for measuring frailty in surgical populations. JAMA Surg. 2017;152(2):175\u2013182. 27893030"},{"issue":"6","key":"b21","series-title":"Ann Surg","first-page":"996","article-title":"Recalibration and external validation of the Risk Analysis Index: a surgical frailty assessment tool","volume":"272","author":"Arya S","year":"2020","unstructured":"Arya S, Varley P, Youk A,  Recalibration and external validation of the Risk Analysis Index: a surgical frailty assessment tool. Ann Surg. 2020;272(6):996\u20131005. 30907757"},{"issue":"6","key":"b22","series-title":"Ann Surg","first-page":"e1230","article-title":"Clinical utility of the Risk Analysis Index as a prospective frailty screening tool within a multi-practice, multi-hospital integrated healthcare system","volume":"274","author":"Varley PR","year":"2021","unstructured":"Varley PR, Borrebach JD, Arya S,  Clinical utility of the Risk Analysis Index as a prospective frailty screening tool within a multi-practice, multi-hospital integrated healthcare system. Ann Surg. 2021;274(6):e1230\u2013e1237. 32118596"},{"issue":"3","key":"b23","series-title":"J Am Coll Surg","first-page":"420","article-title":"Validation of new readmission data in the American College of Surgeons National Surgical Quality Improvement Program","volume":"216","author":"Sellers MM","year":"2013","unstructured":"Sellers MM, Merkow RP, Halverson A,  Validation of new readmission data in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg. 2013;216(3):420\u2013427. 23332220"},{"issue":"2","key":"b24","series-title":"Neurosurgery","first-page":"269","article-title":"Validation of an International Classification of Diseases, Ninth Revision code algorithm for identifying Chiari malformation type 1 surgery in adults","volume":"77","author":"Greenberg JK","year":"2015","unstructured":"Greenberg JK, Ladner TR, Olsen MA,  Validation of an International Classification of Diseases, Ninth Revision code algorithm for identifying Chiari malformation type 1 surgery in adults. Neurosurgery. 2015;77(2):269\u2013273. 25924208"},{"issue":"3","key":"b25","series-title":"Childs Nerv Syst","first-page":"525","article-title":"Systematic review and meta-analysis of imaging characteristics in Chiari I malformation: does anything really matter?","volume":"36","author":"Atchley TJ","year":"2020","unstructured":"Atchley TJ, Alford EN, Rocque BG. Systematic review and meta-analysis of imaging characteristics in Chiari I malformation: does anything really matter?. Childs Nerv Syst. 2020;36(3):525\u2013534. 31701278"},{"issue":"2","key":"b26","series-title":"Evid Based Spine Care J","first-page":"116","article-title":"Persistent\/recurrent syringomyelia after Chiari decompression-natural history and management strategies: a systematic review","volume":"4","author":"Schuster JM","year":"2013","unstructured":"Schuster JM, Zhang F, Norvell DC, Hermsmeyer JT. Persistent\/recurrent syringomyelia after Chiari decompression-natural history and management strategies: a systematic review. Evid Based Spine Care J. 2013;4(2):116\u2013125. 24436709"},{"issue":"5","key":"b27","series-title":"J Neurosurg Pediatr","first-page":"439","article-title":"The addition of duraplasty to posterior fossa decompression in the surgical treatment of pediatric Chiari malformation Type I: a systematic review and meta-analysis of surgical and performance outcomes","volume":"20","author":"Lu VM","year":"2017","unstructured":"Lu VM, Phan K, Crowley SP, Daniels DJ. The addition of duraplasty to posterior fossa decompression in the surgical treatment of pediatric Chiari malformation Type I: a systematic review and meta-analysis of surgical and performance outcomes. J Neurosurg Pediatr. 2017;20(5):439\u2013449. 28885133"},{"issue":"3","key":"b28","series-title":"J Neurooncol","first-page":"595","article-title":"Non-routine discharge disposition is associated with post-discharge complications and 30-day readmissions following craniotomy for brain tumor resection","volume":"136","author":"Lakomkin N","year":"2018","unstructured":"Lakomkin N, Hadjipanayis CG. Non-routine discharge disposition is associated with post-discharge complications and 30-day readmissions following craniotomy for brain tumor resection. J Neurooncol. 2018;136(3):595\u2013604. 29209875"},{"key":"b29","series-title":"World Neurosurg","first-page":"e427","article-title":"Predictors of discharge disposition following laminectomy for intradural extramedullary spinal tumors","volume":"123","author":"Ahn A","year":"2019","unstructured":"Ahn A, Phan K, Cheung ZB, White SJW, Kim JS, Cho SKW. Predictors of discharge disposition following laminectomy for intradural extramedullary spinal tumors. World Neurosurg. 2019;123:e427\u2013e432. 30500579"},{"key":"b30","series-title":"Clin Neurol Neurosurg","first-page":"106902","article-title":"Patient- and hospital-related risk factors for non-routine discharge after lumbar decompression and fusion for spondylolisthesis","volume":"209","author":"Elsamadicy AA","year":"2021","unstructured":"Elsamadicy AA, Freedman IG, Koo AB,  Patient- and hospital-related risk factors for non-routine discharge after lumbar decompression and fusion for spondylolisthesis. Clin Neurol Neurosurg. 2021;209:106902. 34481141"},{"key":"b31","series-title":"BMC Geriatr","first-page":"5","article-title":"Factors influencing home discharge after inpatient rehabilitation of older patients: a systematic review","volume":"16","author":"Everink IHJ","year":"2016","unstructured":"Everink IHJ, van Haastregt JCM, van Hoof SJM, Schols JMGA, Kempen GIJM. Factors influencing home discharge after inpatient rehabilitation of older patients: a systematic review. BMC Geriatr. 2016;16:5. 26755206"},{"issue":"12","key":"b32","series-title":"J Am Geriatr Soc","first-page":"2909","article-title":"Association between patient-reported frailty and non-home discharge among older adults undergoing surgery","volume":"68","author":"Sokas CM","year":"2020","unstructured":"Sokas CM, Cowan J, Dalton MK,  Association between patient-reported frailty and non-home discharge among older adults undergoing surgery. J Am Geriatr Soc. 2020;68(12):2909\u20132913. 33031587"},{"issue":"9","key":"b33","series-title":"Neurol Res","first-page":"760","article-title":"Long-term outcomes of surgical management in subtypes of Chiari malformation","volume":"43","author":"Basaran R","year":"2021","unstructured":"Basaran R, Bozdogan C, Senol M, Gundogan D, Isik N. Long-term outcomes of surgical management in subtypes of Chiari malformation. Neurol Res. 2021;43(9):760\u2013766. 34057045"},{"key":"b34","series-title":"Clin Neurol Neurosurg","first-page":"106757","article-title":"Inpatient outcomes of posterior fossa decompression with or without duraplasty for Chiari malformation type I","volume":"207","author":"Fuentes AM","year":"2021","unstructured":"Fuentes AM, Chiu RG, Nie J, Mehta AI. Inpatient outcomes of posterior fossa decompression with or without duraplasty for Chiari malformation type I. Clin Neurol Neurosurg. 2021;207:106757."},{"key":"b35","series-title":"World Neurosurg","first-page":"526","article-title":"Novel risk calculator for suboccipital decompression for adult Chiari malformation","volume":"139","author":"Feghali J","year":"2020","unstructured":"Feghali J, Marinaro E, Lubelski D, Luciano MG, Huang J. Novel risk calculator for suboccipital decompression for adult Chiari malformation. World Neurosurg. 2020;139:526\u2013534. 32360928"},{"issue":"11","key":"b36","series-title":"Childs Nerv Syst","first-page":"2165","article-title":"Thirty-day outcomes for posterior fossa decompression in children with Chiari type 1 malformation from the US NSQIP-Pediatric database","volume":"32","author":"Vedantam A","year":"2016","unstructured":"Vedantam A, Mayer RR, Staggers KA, Harris DA, Pan IW, Lam SK. Thirty-day outcomes for posterior fossa decompression in children with Chiari type 1 malformation from the US NSQIP-Pediatric database. Childs Nerv Syst. 2016;32(11):2165\u20132171. 27392442"},{"key":"b37","series-title":"World Neurosurg","first-page":"e490","article-title":"Adult Chiari I malformations: an analysis of surgical risk factors and complications using an international database","volume":"115","author":"Bhimani AD","year":"2018","unstructured":"Bhimani AD, Esfahani DR, Denyer S,  Adult Chiari I malformations: an analysis of surgical risk factors and complications using an international database. World Neurosurg. 2018;115:e490\u2013e500."},{"issue":"2","key":"b38","series-title":"J Neurooncol","first-page":"285","article-title":"Preoperative frailty measured by risk analysis index predicts complications and poor discharge outcomes after Brain Tumor Resection in a large multi-center analysis","volume":"160","author":"Thommen R","year":"2022","unstructured":"Thommen R, Kazim SF, Rumalla K,  Preoperative frailty measured by risk analysis index predicts complications and poor discharge outcomes after Brain Tumor Resection in a large multi-center analysis. J Neurooncol. 2022;160(2):285\u2013297."},{"issue":"4","key":"b39","series-title":"Age Ageing","first-page":"673","article-title":"Use of the MMRI-R prognostic tool for older patients discharged to nursing homes from hospital: a prospective cohort study","volume":"44","author":"Dutta R","year":"2015","unstructured":"Dutta R, Hooper J, Dutta D. Use of the MMRI-R prognostic tool for older patients discharged to nursing homes from hospital: a prospective cohort study. Age Ageing. 2015;44(4):673\u2013676."},{"issue":"1","key":"b40","series-title":"Clin Geriatr Med","first-page":"17","article-title":"Frailty defined by deficit accumulation and geriatric medicine defined by frailty","volume":"27","author":"Rockwood K","year":"2011","unstructured":"Rockwood K, Mitnitski A. Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med. 2011;27(1):17\u201326. 21093719"},{"issue":"3","key":"b41","series-title":"J Gerontol A Biol Sci Med Sci","first-page":"M146","article-title":"Frailty in older adults: evidence for a phenotype","volume":"56","author":"Fried LP","year":"2001","unstructured":"Fried LP, Tangen CM, Walston J,  Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146\u2013M156. 11253156"},{"issue":"3","key":"b42","series-title":"JAMA Surg","first-page":"233","article-title":"Association of a frailty screening initiative with postoperative survival at 30, 180, and 365 days","volume":"152","author":"Hall DE","year":"2017","unstructured":"Hall DE, Arya S, Schmid KK,  Association of a frailty screening initiative with postoperative survival at 30, 180, and 365 days. JAMA Surg. 2017;152(3):233\u2013240. 27902826"},{"issue":"3","key":"b1","series-title":"J Neurosurg Pediatr","first-page":"217","article-title":"The Chiari I malformation","volume":"24","author":"McClugage SG","year":"2019","unstructured":"McClugage SG, Oakes WJ. The Chiari I malformation. J Neurosurg Pediatr. 2019;24(3):217\u2013226. 31473667"},{"issue":"12","key":"b2","series-title":"Neurol Sci","first-page":"4965","article-title":"The management of Chiari malformation type 1 and syringomyelia in children: a review of the literature","volume":"42","author":"Saletti V","year":"2021","unstructured":"Saletti V, Farinotti M, Peretta P,  The management of Chiari malformation type 1 and syringomyelia in children: a review of the literature. Neurol Sci. 2021;42(12):4965\u20134995. 34591209"},{"issue":"6","key":"b3","series-title":"Radiol Technol","first-page":"555","article-title":"Chiari malformation and syringomyelia","volume":"79","author":"Snyder P","year":"2008","unstructured":"Snyder P. Chiari malformation and syringomyelia. Radiol Technol. 2008;79(6):555\u2013558. 18650532"},{"issue":"3","key":"b4","series-title":"Neurol Res","first-page":"232","article-title":"The pathogenesis of Chiari I malformation and syringomyelia","volume":"33","author":"Sekula RF Jr","year":"2011","unstructured":"Sekula RF Jr, Arnone GD, Crocker C, Aziz KM, Alperin N. The pathogenesis of Chiari I malformation and syringomyelia. Neurol Res. 2011;33(3):232\u2013239. 21513643"},{"issue":"5","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"519","article-title":"Chiari malformation Type I surgery in pediatric patients. Part 1: validation of an ICD-9-CM code search algorithm","volume":"17","author":"Ladner TR","year":"2016","unstructured":"Ladner TR, Greenberg JK, Guerrero N,  Chiari malformation Type I surgery in pediatric patients. Part 1: validation of an ICD-9-CM code search algorithm. J Neurosurg Pediatr. 2016;17(5):519\u2013524. 26799412"},{"key":"b6","series-title":"World Neurosurg","first-page":"213","article-title":"Chiari malformation type 1: a systematic review of natural history and conservative management","volume":"104","author":"Langridge B","year":"2017","unstructured":"Langridge B, Phillips E, Choi D. Chiari malformation type 1: a systematic review of natural history and conservative management. World Neurosurg. 2017;104:213\u2013219. 28435116"},{"issue":"1","key":"b7","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Surgical treatment of Chiari I malformation: indications and approaches","volume":"11","author":"Alden TD","year":"2001","unstructured":"Alden TD, Ojemann JG, Park TS. Surgical treatment of Chiari I malformation: indications and approaches. Neurosurg Focus. 2001;11(1):E2. 16724812"},{"issue":"2","key":"b8","series-title":"Childs Nerv Syst","first-page":"659","article-title":"Chiari I malformation with neurogenic hypertension after suboccipital decompression","volume":"37","author":"Alluhaybi AA","year":"2021","unstructured":"Alluhaybi AA, Abdulqader SB, Alanazi T, Altuhayni K, Albanyan A. Chiari I malformation with neurogenic hypertension after suboccipital decompression. Childs Nerv Syst. 2021;37(2):659\u2013663. 32435888"},{"key":"b9","series-title":"World Neurosurg","first-page":"1057.e9","article-title":"Subdural fluid collection and hydrocephalus after foramen magnum decompression for Chiari malformation type I: management algorithm of a rare complication","volume":"106","author":"Rossini Z","year":"2017","unstructured":"Rossini Z, Milani D, Costa F, Castellani C, Lasio G, Fornari M. Subdural fluid collection and hydrocephalus after foramen magnum decompression for Chiari malformation type I: management algorithm of a rare complication. World Neurosurg. 2017;106:1057.e9\u20131057.e15. 28754644"},{"issue":"3","key":"b10","series-title":"J Craniovertebr Junction Spine","first-page":"169","article-title":"Complication rates following Chiari malformation surgical management for Arnold-Chiari type I based on surgical variables: a national perspective","volume":"11","author":"Passias PG","year":"2020","unstructured":"Passias PG, Naessig S, Para A,  Complication rates following Chiari malformation surgical management for Arnold-Chiari type I based on surgical variables: a national perspective. J Craniovertebr Junction Spine. 2020;11(3):169\u2013172. 33100765"},{"key":"b11","series-title":"World Neurosurg","first-page":"959","article-title":"Preoperative Frailty Score for 30-day morbidity and mortality after cranial neurosurgery","volume":"107","author":"Tomlinson SB","year":"2017","unstructured":"Tomlinson SB, Piper K, Kimmell KT, Vates GE. Preoperative Frailty Score for 30-day morbidity and mortality after cranial neurosurgery. World Neurosurg. 2017;107:959\u2013965. 28736345"},{"issue":"6","key":"b12","series-title":"Am J Cancer Res","first-page":"3294","article-title":"Frailty is associated with mortality in brain tumor patients","volume":"11","author":"Torres-Perez P","year":"2021","unstructured":"Torres-Perez P, \u00c1lvarez-Satta M, Arrazola M,  Frailty is associated with mortality in brain tumor patients. Am J Cancer Res. 2021;11(6):3294\u20133303. 34249463"},{"issue":"4","key":"b13","series-title":"Neurosurg Focus","first-page":"E15","article-title":"The role of frailty in geriatric cranial neurosurgery for primary central nervous system neoplasms","volume":"49","author":"Shahrestani S","year":"2020","unstructured":"Shahrestani S, Lehrich BM, Tafreshi AR,  The role of frailty in geriatric cranial neurosurgery for primary central nervous system neoplasms. Neurosurg Focus. 2020;49(4):E15. 33002865"},{"issue":"1","key":"b14","series-title":"Neurosurg Rev","first-page":"189","article-title":"The immense heterogeneity of frailty in neurosurgery: a systematic literature review","volume":"44","author":"Pazniokas J","year":"2021","unstructured":"Pazniokas J, Gandhi C, Theriault B,  The immense heterogeneity of frailty in neurosurgery: a systematic literature review. Neurosurg Rev. 2021;44(1):189\u2013201. 31953785"},{"key":"b15","series-title":"World Neurosurg","first-page":"e626","article-title":"The Modified 5-Item Frailty Index: a concise and useful tool for assessing the impact of frailty on postoperative morbidity following elective posterior lumbar fusions","volume":"124","author":"Weaver DJ","year":"2019","unstructured":"Weaver DJ, Malik AT, Jain N, Yu E, Kim J, Khan SN. The Modified 5-Item Frailty Index: a concise and useful tool for assessing the impact of frailty on postoperative morbidity following elective posterior lumbar fusions. World Neurosurg. 2019;124:e626\u2013e632."},{"issue":"14","key":"b16","series-title":"Spine (Phila Pa 1976).","first-page":"939","article-title":"The Five-item Modified Frailty Index is predictive of 30-day postoperative complications in patients undergoing spine surgery","volume":"46","author":"Pierce KE","year":"2021","unstructured":"Pierce KE, Naessig S, Kummer N,  The Five-item Modified Frailty Index is predictive of 30-day postoperative complications in patients undergoing spine surgery. Spine (Phila Pa 1976).2021;46(14):939\u2013943. 34160372"},{"issue":"2","key":"b17","series-title":"J Am Coll Surg","first-page":"173","article-title":"New 5-Factor Modified Frailty Index using American College of Surgeons NSQIP data","volume":"226","author":"Subramaniam S","year":"2018","unstructured":"Subramaniam S, Aalberg JJ, Soriano RP, Divino CM. New 5-Factor Modified Frailty Index using American College of Surgeons NSQIP data. J Am Coll Surg. 2018;226(2):173\u2013181.e8. 29155268"},{"issue":"9","key":"b18","series-title":"Am Surg","first-page":"1420","article-title":"The 5-Factor Modified Frailty Index in the geriatric surgical population","volume":"87","author":"Subramaniam S","year":"2021","unstructured":"Subramaniam S, Aalberg JJ, Soriano RP, Divino CM. The 5-Factor Modified Frailty Index in the geriatric surgical population. Am Surg. 2021;87(9):1420\u20131425. 33377791"},{"key":"b19","series-title":"J Surg Res","first-page":"456","article-title":"The 5 and 11 Factor Modified Frailty Indices are equally effective at outcome prediction using TQIP","volume":"255","author":"Tracy BM","year":"2020","unstructured":"Tracy BM, Adams MA, Schenker ML, Gelbard RB. The 5 and 11 Factor Modified Frailty Indices are equally effective at outcome prediction using TQIP. J Surg Res. 2020;255:456\u2013462. 32619861"},{"issue":"2","key":"b20","series-title":"JAMA Surg","first-page":"175","article-title":"Development and initial validation of the Risk Analysis Index for measuring frailty in surgical populations","volume":"152","author":"Hall DE","year":"2017","unstructured":"Hall DE, Arya S, Schmid KK,  Development and initial validation of the Risk Analysis Index for measuring frailty in surgical populations. JAMA Surg. 2017;152(2):175\u2013182. 27893030"},{"issue":"6","key":"b21","series-title":"Ann Surg","first-page":"996","article-title":"Recalibration and external validation of the Risk Analysis Index: a surgical frailty assessment tool","volume":"272","author":"Arya S","year":"2020","unstructured":"Arya S, Varley P, Youk A,  Recalibration and external validation of the Risk Analysis Index: a surgical frailty assessment tool. Ann Surg. 2020;272(6):996\u20131005. 30907757"},{"issue":"6","key":"b22","series-title":"Ann Surg","first-page":"e1230","article-title":"Clinical utility of the Risk Analysis Index as a prospective frailty screening tool within a multi-practice, multi-hospital integrated healthcare system","volume":"274","author":"Varley PR","year":"2021","unstructured":"Varley PR, Borrebach JD, Arya S,  Clinical utility of the Risk Analysis Index as a prospective frailty screening tool within a multi-practice, multi-hospital integrated healthcare system. Ann Surg. 2021;274(6):e1230\u2013e1237. 32118596"},{"issue":"3","key":"b23","series-title":"J Am Coll Surg","first-page":"420","article-title":"Validation of new readmission data in the American College of Surgeons National Surgical Quality Improvement Program","volume":"216","author":"Sellers MM","year":"2013","unstructured":"Sellers MM, Merkow RP, Halverson A,  Validation of new readmission data in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg. 2013;216(3):420\u2013427. 23332220"},{"issue":"2","key":"b24","series-title":"Neurosurgery","first-page":"269","article-title":"Validation of an International Classification of Diseases, Ninth Revision code algorithm for identifying Chiari malformation type 1 surgery in adults","volume":"77","author":"Greenberg JK","year":"2015","unstructured":"Greenberg JK, Ladner TR, Olsen MA,  Validation of an International Classification of Diseases, Ninth Revision code algorithm for identifying Chiari malformation type 1 surgery in adults. Neurosurgery. 2015;77(2):269\u2013273. 25924208"},{"issue":"3","key":"b25","series-title":"Childs Nerv Syst","first-page":"525","article-title":"Systematic review and meta-analysis of imaging characteristics in Chiari I malformation: does anything really matter?","volume":"36","author":"Atchley TJ","year":"2020","unstructured":"Atchley TJ, Alford EN, Rocque BG. Systematic review and meta-analysis of imaging characteristics in Chiari I malformation: does anything really matter?. Childs Nerv Syst. 2020;36(3):525\u2013534. 31701278"},{"issue":"2","key":"b26","series-title":"Evid Based Spine Care J","first-page":"116","article-title":"Persistent\/recurrent syringomyelia after Chiari decompression-natural history and management strategies: a systematic review","volume":"4","author":"Schuster JM","year":"2013","unstructured":"Schuster JM, Zhang F, Norvell DC, Hermsmeyer JT. Persistent\/recurrent syringomyelia after Chiari decompression-natural history and management strategies: a systematic review. Evid Based Spine Care J. 2013;4(2):116\u2013125. 24436709"},{"issue":"5","key":"b27","series-title":"J Neurosurg Pediatr","first-page":"439","article-title":"The addition of duraplasty to posterior fossa decompression in the surgical treatment of pediatric Chiari malformation Type I: a systematic review and meta-analysis of surgical and performance outcomes","volume":"20","author":"Lu VM","year":"2017","unstructured":"Lu VM, Phan K, Crowley SP, Daniels DJ. The addition of duraplasty to posterior fossa decompression in the surgical treatment of pediatric Chiari malformation Type I: a systematic review and meta-analysis of surgical and performance outcomes. J Neurosurg Pediatr. 2017;20(5):439\u2013449. 28885133"},{"issue":"3","key":"b28","series-title":"J Neurooncol","first-page":"595","article-title":"Non-routine discharge disposition is associated with post-discharge complications and 30-day readmissions following craniotomy for brain tumor resection","volume":"136","author":"Lakomkin N","year":"2018","unstructured":"Lakomkin N, Hadjipanayis CG. Non-routine discharge disposition is associated with post-discharge complications and 30-day readmissions following craniotomy for brain tumor resection. J Neurooncol. 2018;136(3):595\u2013604. 29209875"},{"key":"b29","series-title":"World Neurosurg","first-page":"e427","article-title":"Predictors of discharge disposition following laminectomy for intradural extramedullary spinal tumors","volume":"123","author":"Ahn A","year":"2019","unstructured":"Ahn A, Phan K, Cheung ZB, White SJW, Kim JS, Cho SKW. Predictors of discharge disposition following laminectomy for intradural extramedullary spinal tumors. World Neurosurg. 2019;123:e427\u2013e432. 30500579"},{"key":"b30","series-title":"Clin Neurol Neurosurg","first-page":"106902","article-title":"Patient- and hospital-related risk factors for non-routine discharge after lumbar decompression and fusion for spondylolisthesis","volume":"209","author":"Elsamadicy AA","year":"2021","unstructured":"Elsamadicy AA, Freedman IG, Koo AB,  Patient- and hospital-related risk factors for non-routine discharge after lumbar decompression and fusion for spondylolisthesis. Clin Neurol Neurosurg. 2021;209:106902. 34481141"},{"key":"b31","series-title":"BMC Geriatr","first-page":"5","article-title":"Factors influencing home discharge after inpatient rehabilitation of older patients: a systematic review","volume":"16","author":"Everink IHJ","year":"2016","unstructured":"Everink IHJ, van Haastregt JCM, van Hoof SJM, Schols JMGA, Kempen GIJM. Factors influencing home discharge after inpatient rehabilitation of older patients: a systematic review. BMC Geriatr. 2016;16:5. 26755206"},{"issue":"12","key":"b32","series-title":"J Am Geriatr Soc","first-page":"2909","article-title":"Association between patient-reported frailty and non-home discharge among older adults undergoing surgery","volume":"68","author":"Sokas CM","year":"2020","unstructured":"Sokas CM, Cowan J, Dalton MK,  Association between patient-reported frailty and non-home discharge among older adults undergoing surgery. J Am Geriatr Soc. 2020;68(12):2909\u20132913. 33031587"},{"issue":"9","key":"b33","series-title":"Neurol Res","first-page":"760","article-title":"Long-term outcomes of surgical management in subtypes of Chiari malformation","volume":"43","author":"Basaran R","year":"2021","unstructured":"Basaran R, Bozdogan C, Senol M, Gundogan D, Isik N. Long-term outcomes of surgical management in subtypes of Chiari malformation. Neurol Res. 2021;43(9):760\u2013766. 34057045"},{"key":"b34","series-title":"Clin Neurol Neurosurg","first-page":"106757","article-title":"Inpatient outcomes of posterior fossa decompression with or without duraplasty for Chiari malformation type I","volume":"207","author":"Fuentes AM","year":"2021","unstructured":"Fuentes AM, Chiu RG, Nie J, Mehta AI. Inpatient outcomes of posterior fossa decompression with or without duraplasty for Chiari malformation type I. Clin Neurol Neurosurg. 2021;207:106757."},{"key":"b35","series-title":"World Neurosurg","first-page":"526","article-title":"Novel risk calculator for suboccipital decompression for adult Chiari malformation","volume":"139","author":"Feghali J","year":"2020","unstructured":"Feghali J, Marinaro E, Lubelski D, Luciano MG, Huang J. Novel risk calculator for suboccipital decompression for adult Chiari malformation. World Neurosurg. 2020;139:526\u2013534. 32360928"},{"issue":"11","key":"b36","series-title":"Childs Nerv Syst","first-page":"2165","article-title":"Thirty-day outcomes for posterior fossa decompression in children with Chiari type 1 malformation from the US NSQIP-Pediatric database","volume":"32","author":"Vedantam A","year":"2016","unstructured":"Vedantam A, Mayer RR, Staggers KA, Harris DA, Pan IW, Lam SK. Thirty-day outcomes for posterior fossa decompression in children with Chiari type 1 malformation from the US NSQIP-Pediatric database. Childs Nerv Syst. 2016;32(11):2165\u20132171. 27392442"},{"key":"b37","series-title":"World Neurosurg","first-page":"e490","article-title":"Adult Chiari I malformations: an analysis of surgical risk factors and complications using an international database","volume":"115","author":"Bhimani AD","year":"2018","unstructured":"Bhimani AD, Esfahani DR, Denyer S,  Adult Chiari I malformations: an analysis of surgical risk factors and complications using an international database. World Neurosurg. 2018;115:e490\u2013e500."},{"issue":"2","key":"b38","series-title":"J Neurooncol","first-page":"285","article-title":"Preoperative frailty measured by risk analysis index predicts complications and poor discharge outcomes after Brain Tumor Resection in a large multi-center analysis","volume":"160","author":"Thommen R","year":"2022","unstructured":"Thommen R, Kazim SF, Rumalla K,  Preoperative frailty measured by risk analysis index predicts complications and poor discharge outcomes after Brain Tumor Resection in a large multi-center analysis. J Neurooncol. 2022;160(2):285\u2013297."},{"issue":"4","key":"b39","series-title":"Age Ageing","first-page":"673","article-title":"Use of the MMRI-R prognostic tool for older patients discharged to nursing homes from hospital: a prospective cohort study","volume":"44","author":"Dutta R","year":"2015","unstructured":"Dutta R, Hooper J, Dutta D. Use of the MMRI-R prognostic tool for older patients discharged to nursing homes from hospital: a prospective cohort study. Age Ageing. 2015;44(4):673\u2013676."},{"issue":"1","key":"b40","series-title":"Clin Geriatr Med","first-page":"17","article-title":"Frailty defined by deficit accumulation and geriatric medicine defined by frailty","volume":"27","author":"Rockwood K","year":"2011","unstructured":"Rockwood K, Mitnitski A. Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med. 2011;27(1):17\u201326. 21093719"},{"issue":"3","key":"b41","series-title":"J Gerontol A Biol Sci Med Sci","first-page":"M146","article-title":"Frailty in older adults: evidence for a phenotype","volume":"56","author":"Fried LP","year":"2001","unstructured":"Fried LP, Tangen CM, Walston J,  Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146\u2013M156. 11253156"},{"issue":"3","key":"b42","series-title":"JAMA Surg","first-page":"233","article-title":"Association of a frailty screening initiative with postoperative survival at 30, 180, and 365 days","volume":"152","author":"Hall DE","year":"2017","unstructured":"Hall DE, Arya S, Schmid KK,  Association of a frailty screening initiative with postoperative survival at 30, 180, and 365 days. JAMA Surg. 2017;152(3):233\u2013240. 27902826"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/54\/3\/article-pE6.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/54\/3\/article-pE6.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/54\/3\/article-pE6.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T08:12:41Z","timestamp":1780733561000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/54\/3\/article-pE6.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3]]},"references-count":84,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2022.12.focus22629","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3]]}}}