{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:23:42Z","timestamp":1791563022477,"version":"4.3.4"},"reference-count":19,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Idiopathic normal pressure hydrocephalus (iNPH) predominantly occurs in older patients, and ventriculoperitoneal shunt (VPS) placement is the definitive surgical treatment. VPS surgery carries significant postoperative complication rates, which may tip the risk\/benefit balance of this treatment option for frail, or higher-risk, patients. In this study, the authors investigated the use of frailty scoring for preoperative risk stratification for adverse event prediction in iNPH patients who underwent elective VPS placement.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The Nationwide Readmissions Database (NRD) was queried from 2018 to 2019 for iNPH patients aged \u2265 60 years who underwent VPS surgery. Risk Analysis Index (RAI) and modified 5-item Frailty Index (mFI-5) scores were calculated and RAI cross-tabulation was used to analyze trends in frailty scores by the following binary outcome measures: overall complications, nonhome discharge (NHD), extended length of stay (eLOS) (&gt; 75th percentile), and mortality. Area under the receiver operating characteristic curve analysis was performed to assess the discriminatory accuracy of RAI and mFI-5 for primary outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 9319 iNPH patients underwent VPS surgery, and there were 685 readmissions (7.4%), 593 perioperative complications (6.4%), and 94 deaths (1.0%). Increasing RAI score was significantly associated with increasing rates of postoperative complications: RAI scores 11\u201315, 5.4% (n = 80); 16\u201320, 5.6% (n = 291); 21\u201325, 7.6% (n = 166); and \u2265 26, 11.6% (n = 56). The discriminatory accuracy of RAI was statistically superior (DeLong test, p &lt; 0.05) to mFI-5 for the primary endpoints of mortality, NHD, and eLOS. All RAI C-statistics were &gt; 0.60 for mortality within 30 days (C-statistic = 0.69, 95% CI 0.68\u20130.70).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>In a nationwide database analysis, increasing frailty, as measured by RAI, was associated with NHD, 30-day mortality, unplanned readmission, eLOS, and postoperative complications. Although the RAI outperformed the mFI-5, it is essential to account for the potentially reversible clinical issues related to the underlying disease process, as these factors may inflate frailty scores, assign undue risk, and diminish their utility. This knowledge may enhance provider understanding of the impact of frailty on postoperative outcomes for patients with iNPH, while highlighting the potential constraints associated with frailty assessment tools.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.7.jns23767","type":"journal-article","created":{"date-parts":[[2023,10,7]],"date-time":"2023-10-07T01:39:38Z","timestamp":1696642778000},"page":"1110-1116","source":"Crossref","is-referenced-by-count":9,"title":["Risk Analysis Index as a preoperative frailty tool for elective ventriculoperitoneal shunt surgery for idiopathic normal pressure hydrocephalus"],"prefix":"10.3171","volume":"140","author":[{"given":"Evan","family":"Courville","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of New Mexico Hospital, Albuquerque; and"},{"name":"Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavelin","family":"Rumalla","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of New Mexico Hospital, Albuquerque; and"},{"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; and"},{"name":"Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alis J.","family":"Dicpinigaitis","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of New Mexico Hospital, Albuquerque; and"},{"name":"Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meic","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of New Mexico Hospital, Albuquerque; and"},{"name":"Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy M.","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of New Mexico Hospital, Albuquerque; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian A.","family":"Bowers","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of New Mexico Hospital, Albuquerque; and"},{"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":"N Engl J Med","first-page":"117","article-title":"Symptomatic occult hydrocephalus with normal cerebrospinal-fluid pressure: a treatable syndrome","volume":"273","author":"Adams RD","year":"1965","unstructured":"Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH. Symptomatic occult hydrocephalus with normal cerebrospinal-fluid pressure: a treatable syndrome. N Engl J Med. 1965;273(3):117\u2013126."},{"issue":"2","key":"b2","series-title":"Neurochirurgie","first-page":"112","article-title":"Demographic and socioeconomic disparities of benign and malignant spinal meningiomas in the United States","volume":"67","author":"Ghaffari-Rafi A","year":"2021","unstructured":"Ghaffari-Rafi A, Mehdizadeh R, Ghaffari-Rafi S, Leon-Rojas J. Demographic and socioeconomic disparities of benign and malignant spinal meningiomas in the United States. Neurochirurgie. 2021;67(2):112\u2013118."},{"key":"b3","series-title":"World Neurosurg","first-page":"e38","article-title":"Prevalence and trends in management of idiopathic normal pressure hydrocephalus in the United States: insights from the National Inpatient Sample","volume":"145","author":"Alvi MA","year":"2021","unstructured":"Alvi MA, Brown D, Yolcu Y,  Prevalence and trends in management of idiopathic normal pressure hydrocephalus in the United States: insights from the National Inpatient Sample. World Neurosurg. 2021;145:e38\u2013e52."},{"issue":"6","key":"b4","series-title":"Neurosurg Rev","first-page":"1451","article-title":"Normal pressure hydrocephalus\u2014an overview of pathophysiological mechanisms and diagnostic procedures","volume":"43","author":"Skalick\u00fd P","year":"2020","unstructured":"Skalick\u00fd P, Ml\u00e1dek A, Vlas\u00e1k A, De Lacy P, Bene\u0161 V, Brad\u00e1\u010d O. Normal pressure hydrocephalus\u2014an overview of pathophysiological mechanisms and diagnostic procedures. Neurosurg Rev. 2020;43(6):1451\u20131464."},{"key":"b5","series-title":"Front Neurosci","first-page":"751145","article-title":"The impact of multimorbidity burden, frailty risk scoring, and 3-directional morphological indices vs. testing for CSF responsiveness in normal pressure hydrocephalus","volume":"15","author":"Soon SXY","year":"2021","unstructured":"Soon SXY, Kumar AA, Tan AJL,  The impact of multimorbidity burden, frailty risk scoring, and 3-directional morphological indices vs. testing for CSF responsiveness in normal pressure hydrocephalus. Front Neurosci. 2021;15:751145."},{"key":"b6","series-title":"Clin Neurol Neurosurg","first-page":"106178","article-title":"Predictors of adverse outcomes and cost after surgical management for idiopathic normal pressure hydrocephalus: analyses from a national database","volume":"197","author":"Alvi MA","year":"2020","unstructured":"Alvi MA, Brown D, Yolcu YU,  Predictors of adverse outcomes and cost after surgical management for idiopathic normal pressure hydrocephalus: analyses from a national database. Clin Neurol Neurosurg. 2020;197:106178."},{"key":"b7","series-title":"Front Med (Lausanne)","first-page":"596270","article-title":"Impact of comorbidities and frailty on early shunt failure in geriatric patients with normal pressure hydrocephalus","volume":"7","author":"Hadjiathanasiou A","year":"2020","unstructured":"Hadjiathanasiou A, Kilinc F, Behmanesh B,  Impact of comorbidities and frailty on early shunt failure in geriatric patients with normal pressure hydrocephalus. Front Med (Lausanne). 2020;7:596270."},{"issue":"3","key":"b8","series-title":"Anesthesiol Clin","first-page":"453","article-title":"Geriatric physiology and the frailty syndrome","volume":"37","author":"Khan KT","year":"2019","unstructured":"Khan KT, Hemati K, Donovan AL. Geriatric physiology and the frailty syndrome. Anesthesiol Clin. 2019;37(3):453\u2013474."},{"issue":"6","key":"b9","series-title":"Anesth Analg","first-page":"1450","article-title":"Frailty for perioperative clinicians: a narrative review","volume":"130","author":"McIsaac DI","year":"2020","unstructured":"McIsaac DI, MacDonald DB, Aucoin SD. Frailty for perioperative clinicians: a narrative review. Anesth Analg. 2020;130(6):1450\u20131460."},{"issue":"1","key":"b10","series-title":"JAMA Surg","first-page":"e205152","article-title":"Association between patient frailty and postoperative mortality across multiple noncardiac surgical specialties","volume":"156","author":"George EL","year":"2021","unstructured":"George EL, Hall DE, Youk A,  Association between patient frailty and postoperative mortality across multiple noncardiac surgical specialties. JAMA Surg. 2021;156(1):e205152."},{"key":"b11","series-title":"Clin Neurol Neurosurg","first-page":"107383","article-title":"Worse cranial neurosurgical outcomes predicted by increasing frailty in patients with interhospital transfer status: analysis of 47,736 patients from the National Surgical Quality Improvement Program (NSQIP) 2015-2019","volume":"221","author":"Kassicieh AJ","year":"2022","unstructured":"Kassicieh AJ, Varela S, Rumalla K,  Worse cranial neurosurgical outcomes predicted by increasing frailty in patients with interhospital transfer status: analysis of 47,736 patients from the National Surgical Quality Improvement Program (NSQIP) 2015-2019. Clin Neurol Neurosurg. 2022;221:107383."},{"issue":"1","key":"b12","series-title":"JAMA Surg","first-page":"e194620","article-title":"Association of preoperative patient frailty and operative stress with postoperative mortality","volume":"155","author":"Shinall MC Jr","year":"2020","unstructured":"Shinall MC Jr, Arya S, Youk A,  Association of preoperative patient frailty and operative stress with postoperative mortality. JAMA Surg. 2020;155(1):e194620."},{"issue":"2","key":"b13","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."},{"key":"b14","article-title":"Nationwide Readmissions Database (NRD) Database Documentation. Agency for Healthcare Research and Quality","unstructured":"Nationwide Readmissions Database (NRD) Database Documentation. Agency for Healthcare Research and Quality. Accessed August 11, 2023.https:\/\/www.hcup-us.ahrq.gov\/db\/nation\/nrd\/nrddbdocumentation.jsp"},{"key":"b15","article-title":"Clinical Classifications Software Refined (CCSR). Agency for Healthcare Research and Quality","unstructured":"Clinical Classifications Software Refined (CCSR). Agency for Healthcare Research and Quality. Accessed August 11, 2023.https:\/\/www.hcup-us.ahrq.gov\/toolssoftware\/ccsr\/ccs_refined.jsp"},{"issue":"2","key":"b16","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."},{"key":"b17","series-title":"Surg Neurol Int","first-page":"404","article-title":"Advanced frailty assessment tool predicts successful awake craniotomy in a 92-year-old patient: a case report","volume":"13","author":"Cole KL","year":"2022","unstructured":"Cole KL, Varela S, Rumalla K,  Advanced frailty assessment tool predicts successful awake craniotomy in a 92-year-old patient: a case report. Surg Neurol Int. 2022;13:404."},{"issue":"5","key":"b18","series-title":"J Neurol","first-page":"1389","article-title":"Biomechanical response of the CNS is associated with frailty in NPH-suspected patients","volume":"267","author":"Vallet A","year":"2020","unstructured":"Vallet A, Del Campo N, Hoogendijk EO,  Biomechanical response of the CNS is associated with frailty in NPH-suspected patients. J Neurol. 2020;267(5):1389\u20131400."},{"issue":"4","key":"b19","series-title":"Neurosurgery","first-page":"574","article-title":"Cerebrospinal fluid shunting improves long-term quality of life in idiopathic normal pressure hydrocephalus","volume":"86","author":"Israelsson H","year":"2020","unstructured":"Israelsson H, Eklund A, Malm J. Cerebrospinal fluid shunting improves long-term quality of life in idiopathic normal pressure hydrocephalus. Neurosurgery. 2020;86(4):574\u2013582."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/140\/4\/article-p1110.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/140\/4\/article-p1110.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/140\/4\/article-p1110.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,25]],"date-time":"2024-05-25T10:19:17Z","timestamp":1716632357000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/140\/4\/article-p1110.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,1]]},"references-count":19,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2023.7.jns23767","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,1]]}}}