National assessment of frailty impact on endovascular mechanical thrombectomy for minor to moderately severe large vessel occlusions per NIHSS

Abstract

Introduction

Large vessel occlusion (LVO) strokes are a significant cause of disability and death globally. Endovascular mechanical thrombectomy (EVT) has improved outcomes for LVO patients. However, the impact of pre-existing frailty on outcomes for patients undergoing EVT remains understudied.

Methods

This study utilized the National Inpatient Sample (NIS) database to identify patients aged 18 and older who underwent EVT for LVO of the internal carotid artery (ICA) or middle cerebral artery (MCA) from 2016 to 2021. Frailty was assessed using the modified Frailty Index-5 (mFI-5), mFI-11, Charlson Comorbidity Index (CCI), and Risk Analysis Index (RAI). Outcomes analyzed included mortality, complications, length of stay (LOS), discharge disposition, and cost of care.

Results

We analyzed 57,260 EVT admissions. Patients classified as highly frail by the CCI had the highest in-hospital mortality (odds ratio (OR) 1.13, p < 0.0001). High frailty identified by mFI-5 was associated with a higher likelihood of postoperative complications (OR 1.41, p < 0.0001) and extended LOS (OR 1.23, p < 0.0001). High frailty by the administrative RAI was linked to nonhome discharge (OR 1.31, p < 0.0001), with mFI-5 showing similar predictive value (OR 1.30, p < 0.0001). High frailty, as determined by the CCI, incurred the highest estimated cost of care (p < 0.0001).

Conclusions

Frailty assessment using mFI-5 is a practical predictor of patient outcomes in LVO thrombectomy, including complication rates, extended LOS, and discharge disposition. The CCI remains the most predictive for mortality, though it is more complex to calculate. We emphasize that frailty, as measured by the mFI-5, is one of many factors to consider when deciding on EVT for LVO.