NYMC Faculty Publications

Frailty and Outcomes in Lacunar Stroke

Authors

Sima Vazquez, School of Medicine, New York Medical College, Valhalla, NY, United States.
Zehavya Stadlan, School of Medicine, New York Medical College, Valhalla, NY, United States.
Justin M. Lapow, School of Medicine, New York Medical College, Valhalla, NY, United States.
Eric Feldstein, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, United States.
Smit Shah, Department of Neurology, University of South Carolina/PRISMA Health Richland, Columbia, SC, United States.
Ankita Das, School of Medicine, New York Medical College, Valhalla, NY, United States.
Alexandria F. Naftchi, School of Medicine, New York Medical College, Valhalla, NY, United States.
Eris Spirollari, School of Medicine, New York Medical College, Valhalla, NY, United States.
Akash Thaker, School of Medicine, New York Medical College, Valhalla, NY, United States.
Syed Faraz Kazim, Department of Neurosurgery, University of New Mexico, Albuquerque, NM, United States.
Jose F. Dominguez, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, United States.
Neisha Patel, Department of Neurology, Westchester Medical Center, Valhalla, NY, United States.
Christeena Kurian, Department of Neurology, Westchester Medical Center, Valhalla, NY, United States.
Ji Chong, Department of Neurology, Westchester Medical Center, Valhalla, NY, United States.
Stephan A. Mayer, Department of Neurology, Westchester Medical Center, Valhalla, NY, United States.
Gurmeen Kaur, Department of Neurology, Westchester Medical Center, Valhalla, NY, United States.
Chirag D. Gandhi, School of Medicine, New York Medical College, Valhalla, NY, United States; Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, United States.
Christian A. Bowers, Department of Neurosurgery, University of New Mexico, Albuquerque, NM, United States.
Fawaz Al-Mufti, School of Medicine, New York Medical College, Valhalla, NY, United States; Department of Neurology, Westchester Medical Center, Valhalla, NY, United States.

Author Type(s)

Student, Resident/Fellow, Faculty

Journal Title

Journal of Stroke and Cerebrovascular Diseases

First Page

106942

Document Type

Article

Publication Date

2-1-2023

Department

Neurosurgery

Second Department

Neurology

Abstract

BACKGROUND: Lacunar strokes (LS) are ischemic strokes of the small perforating arteries of deep gray and white matter of the brain. Frailty has been associated with greater mortality and attenuated response to treatment after stroke. However, the effect of frailty on patients with LS has not been previously described. OBJECTIVE: To analyze the association between frailty and outcomes in LS. METHODS: Patients with LS were selected from the National Inpatient Sample (NIS) 2016-2019 using the International Classification of Disease, 10 edition (ICD-10) diagnosis codes. The 11-point modified frailty scale (mFI-11) was used to group patients into severely frail and non-severely frail cohorts. Demographics, clinical characteristics, and complications were defined. Health care resource utilization (HRU) was evaluated by comparing total hospital charges and length of stay (LOS). Other outcomes studied were discharge disposition and inpatient death. RESULTS: Of 48,980 patients with LS, 10,830 (22.1%) were severely frail. Severely frail patients were more likely to be older, have comorbidities, and pertain to lower socioeconomic status categories. Severely frail patients with LS had worse clinical stroke severity and increased rates of complications such as urinary tract infection (UTI) and pneumonia (PNA). Additionally, severe frailty was associated with unfavorable outcomes and increased HRU. CONCLUSION: Severe frailty in LS patients is associated with higher rates of complications and increased HRU. Risk stratification based on frailty may allow for individualized treatments to help mitigate adverse outcomes in the setting of LS.

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