Geriatrics & Gerontology International · Jun 9, 2025
Impact of frailty risk on postoperative activities of daily living and in-hospital events in older patients with hydrocephalus using a nationwide Japanese database
By Igarashi T, Kamo T, Miyata K et al.
AIM: Understanding the impact of frailty risk on outcomes after hydrocephalus surgery in older adults is critical for improving prognosis and guiding tailored treatment strategies. This study evaluated the effect of frailty risk on postoperative activities of daily living (ADL) and in-hospital events in older patients with hydrocephalus, using a nationwide Japanese database. METHODS: A retrospective study was conducted on older patients who underwent cerebrospinal fluid shunt surgery. Frailty risk was assessed using the Hospital Frailty Risk Score (HFRS) based on ICD-10 codes. Patients were categorized into low (<5 points) and moderate-to-high (≥5 points) frailty risk groups. Outcomes included the Barthel Index (BI) at discharge, BI gain, BI efficiency, and incidences of dysphagia and delirium. Propensity score-based inverse probability weighting was applied to adjust for confounding. RESULTS: Among 3075 patients, 1539 were at low risk and 1526 were at moderate-to-high risk of frailty. Moderate-to-high frailty risk significantly reduced BI at discharge (β = -0.10, P < 0.001), BI gain (β = -0.07, P < 0.001), and BI efficiency (β = -0.07, P < 0.001). Frailty risk also increased the odds of dysphagia (odds ratio = 1.86, P = 0.017) and delirium (odds ratio = 31.07, P < 0.001). CONCLUSIONS: Moderate-to-high frailty risk negatively impacts postoperative ADL recovery and increases dysphagia and delirium risk in older patients with hydrocephalus. These findings highlight the need for early frailty assessment and tailored interventions to improve surgical outcomes. Geriatr Gerontol Int 2025; 25: 960-966.