328 Utility of Combining Frailty and Comorbid Disease Indices to Better Predict Outcomes Following Craniotomy for Pediatric Primary Brain Tumors

INTRODUCTION: The utility of Frailty and comorbid disease indices in pediatric patients undergoing cranial tumor resection is unclear. Most of these indices have only been validated for use in adult populations, and no such index currently exists for pediatric neurosurgical patients. Some categories utilized in these indices, such as fecal incontinence, weight loss, and renal failure, can be assessed in this population to predict post-surgical outcomes. METHODS: The Nationwide Readmissions Database (NRD) was queried for pediatric patients undergoing primary brain tumor resection between 2016 and 2019. Frailty, ECI, and Frailty+ECI were assessed as predictors using generalized linear mixed-effects models. Receiver operating characteristic (ROC) curves evaluated predictive performance. RESULTS: A total of 237 and 1,235 patients with benign and malignant tumors were identified, respectively. Frailty+ECI, Frailty, and ECI scores performed similarly in predicting hospital LOS, non-routine discharge, and one-year readmission in the benign tumor cohort. In the malignant cohort, Frailty+ECI (AUC 0.895) outperformed Frailty alone (AUC 0.742, p = 0.001) but performed similarly to ECI score alone (AUC 0.893, p = 0.438) in predicting hospital LOS. Concerning non-routine discharge prediction, Frailty+ECI (AUC 0.871) also outperformed Frailty alone (AUC 0.744, p = 0.04) while performing similarly to ECI score alone (AUC 0.869, p = 0.871). All indices performed similarly to predict one-year readmission in this cohort. CONCLUSIONS: Our study demonstrated that Frailty+ECI demonstrated a robust ability to predict hospital LOS and non-routine discharge disposition in pediatric patients undergoing malignant brain tumor resection. These findings suggest that combining these indices may improve the prediction of postoperative outcomes in this population, warranting further studies.