尽管人们对患者虚弱如何影响结果（例如在神经肿瘤学中）越来越感兴趣，但其在库欣病（CD）经蝶手术后的作用仍不清楚。我们使用美国学术垂体中心合作的垂体腺瘤及相关疾病登记处 (RAPID) 数据集评估了虚弱对 CD 结局的影响。连续接受手术治疗的 CD 患者 (2011-2023) 的数据使用以下方法编制： 11 因素修正衰弱指数。患者被分为健康（评分，0-1）、管理良好（评分，2-3）和轻度虚弱（评分，4-5）。进行单变量和多变量分析来检查结果。分析了 318 名患者的数据（193 名健康，113 名管理良好，12 名轻度虚弱）。与身体健康且管理良好的患者相比，轻度体弱患者年龄较大（平均值±SD 39.7±14.2和48.9±12.2 vs 49.4±8.9岁，P < .001），但性别、种族和其他因素没有差异。即使在针对延长住院时间的已知预测因素（年龄、Knosp）进行多变量分析（β = 1.01，P = .007）调整后，他们的住院时间也显着延长（3.7 ± 2.0 和 4.5 ± 3.5 vs 5.3 ± 3.5 天，P = .02）等级、外科医生经验、美国麻醉医师协会等级、并发症、虚弱）。轻度虚弱的患者更常出院到熟练的护理机构（0.5% [1/192] 和 4.5% [5/112] vs 25% [3/12]，P < .001）。大多数患者接受了总体切除（84.4% [163/193] 和 79.6% [90/113] vs 83% [10/12]）。总体并发症没有观察到差异；然而，静脉血栓栓塞在轻度虚弱 (8%, 1/12) 患者中比健康 (0.5%, 1/193) 和管理良好 (2.7%, 3/113) 患者更常见 (P = .04)。 90 天的再入院率没有发现差异。这些结果表明，轻度虚弱可预测 CD 手术结果，并可能为术前风险分层提供信息。除年龄和肿瘤特征外，受虚弱影响的结果可能对预测有用。未来的研究可以帮助确定减轻高皮质醇血症虚弱患者疾病负担的策略。版权所有 © 神经外科医生大会 2024。保留所有权利。

Despite growing interest in how patient frailty affects outcomes (eg, in neuro-oncology), its role after transsphenoidal surgery for Cushing disease (CD) remains unclear. We evaluated the effect of frailty on CD outcomes using the Registry of Adenomas of the Pituitary and Related Disorders (RAPID) data set from a collaboration of US academic pituitary centers.Data on consecutive surgically treated patients with CD (2011-2023) were compiled using the 11-factor modified frailty index. Patients were classified as fit (score, 0-1), managing well (score, 2-3), and mildly frail (score, 4-5). Univariable and multivariable analyses were conducted to examine outcomes.Data were analyzed for 318 patients (193 fit, 113 managing well, 12 mildly frail). Compared with fit and managing well patients, mildly frail patients were older (mean ± SD 39.7 ± 14.2 and 48.9 ± 12.2 vs 49.4 ± 8.9 years, P < .001) but did not different by sex, race, and other factors. They had significantly longer hospitalizations (3.7 ± 2.0 and 4.5 ± 3.5 vs 5.3 ± 3.5 days, P = .02), even after multivariable analysis (β = 1.01, P = .007) adjusted for known predictors of prolonged hospitalization (age, Knosp grade, surgeon experience, American Society of Anesthesiologists grade, complications, frailty). Patients with mild frailty were more commonly discharged to skilled nursing facilities (0.5% [1/192] and 4.5% [5/112] vs 25% [3/12], P < .001). Most patients underwent gross total resection (84.4% [163/193] and 79.6% [90/113] vs 83% [10/12]). No difference in overall complications was observed; however, venous thromboembolism was more common in mildly frail (8%, 1/12) than in fit (0.5%, 1/193) and managing well (2.7%, 3/113) patients (P = .04). No difference was found in 90-day readmission rates.These results demonstrate that mild frailty predicts CD surgical outcomes and may inform preoperative risk stratification. Frailty-influenced outcomes other than age and tumor characteristics may be useful for prognostication. Future studies can help identify strategies to reduce disease burden for frail patients with hypercortisolemia.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.