Clin Neurol Neurosurg. 2026 Feb 5;263:109340. doi: 10.1016/j.clineuro.2026.109340. Online ahead of print.
ABSTRACT
BACKGROUND/OBJECTIVES: This study aims to assess the composite impact of frailty, malnutrition, and anemia on postoperative outcomes for elderly subdural hemorrhage (SDH) patients.
METHODS: A retrospective cohort study was performed using the 2011-2023 NSQIP database. All patients > 65 years who underwent SDH evacuation were identified using CPT and ICD codes. The study population was divided based on RAI-rev frailty status, with frail patients being further subdivided based on anemia and Geriatric Nutritional Risk Index (GNRI) nutritional status. Using receiver operating characteristic (ROC) and multivariable analyses, we compared the discriminative thresholds and independent associations of these health condition combinations with extended hospital length of stay (LOS), any 30-day adverse event (AE), non-routine discharge (NRD), and 30-day mortality.
RESULTS: Of 3136 elderly SDH patients, 610 (19.5 %) were Frail Alone (F), 712 (22.7 %) were Frail + Anemic (FA), 464 (14.8 %) were Frail + Malnourished (FM), 1226 (39.1 %) were FA + Malnourished (FAM), and 124 (4.0 %) were Not Frail (NF). RAI-rev was a risk factor for extended LOS (aOR: 1.03, 95 % CI: 1.01-1.06), AEs (aOR: 1.04, 95 % CI: 1.02-1.06), and mortality (aOR: 1.05, 95 % CI: 1.03-1.08). GNRI was a predictor of decreased odds of extended LOS (aOR: 0.98, 95 % CI: 0.97-0.99) and NRD (aOR: 0.98, 95 % CI: 0.97-1.00), whereas anemia only predicted AEs (aOR: 1.58, 95 % CI: 1.27-1.96). On ROC analysis, adding anemia and GNRI to RAI-rev was associated with statistically significant (p = 0.034) but modest improvements in discrimination for 30-day adverse events.
CONCLUSION: Our findings suggest that adding anemia and GNRI to RAI-rev is associated with a modest incremental improvement in discrimination for 30-day adverse events in elderly SDH patients.
PMID:41655319 | DOI:10.1016/j.clineuro.2026.109340
