Use of the 5-Factor Modified Frailty Index to Predict Hospital-Acquired Infections and Length of Stay Among Neurotrauma Patients Undergoing Emergent Craniotomy/Craniectomy

Objective: Traumatic brain injury is a significant public health concern often complicated by hospital-acquired infections (HAIs); however, previous evaluations of factors predictive of risk for HAI have generally been single-center analyses or limited to surgical site infections. Frailty assessment has been shown to provide effective risk stratification in neurosurgery. We evaluated whether frailty status or age is more predictive of HAIs and length of stay among neurotrauma patients requiring craniectomy/craniotomy. Methods: In this cross-sectional analysis, the American College of Surgeons National Surgical Quality Improvement Program 2015–2019 dataset was queried to identify neurotrauma patients who underwent craniectomies/craniotomies. The effects of frailty status (using the 5-factor modified frailty index [mFI-5]) and age on occurrence of HAIs and other 30-day adverse events were compared using univariate analysis. The discriminative ability of each measure was defined by multivariate modeling. Results: Of 3284 patients identified, 1172 (35.7%) contracted an HAI postoperatively. Increasing frailty score predicted increased HAI risk (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.05–1.77, P = 0.022 for mFI-5 = 1 and OR = 2.01, 95% CI = 1.30–3.11, P = 0.002 for mFI-5≥3), whereas increasing age did not (OR = 0.996, 95% CI = 0.989–1.002, P = 0.009). Median length of stay was significantly longer in patients with HAI (16 days [IQR = 9–23]) versus no HAI (7 days [IQR = 4–13]) (P < 0.001). Median daily costs on the ward and neuro-intensive care unit were higher with HAI than with no HAI (neuro-ICU: $111,818.08 [IQR = 46,418.05–189,947.34] vs. $48,920.41 [IQR = 20,185.20–107,712.54], P < 0.001). Conclusions: Increasing mFI-5 correlated with increased HAI risk. Neurotrauma patients who developed an HAI after craniectomy/craniotomy had longer hospitalizations and higher care costs. Frailty scoring improves risk stratification among these patients and may assist in reducing total hospital length of stay and total accrued costs to patients.