Frailty is an emerging concept in clinical practice used to predict outcomes and dictate treatment algorithms. Frail patients, especially older adults, are at higher risk for adverse outcomes. Aneurysmal subarachnoid hemorrhage (aSAH) is a neurosurgical emergency associated with high morbidity and mortality rates that have previously been shown to correlate with frailty. However, the relationship between treatment selection and post-treatment outcomes in frail aSAH patients is not established. We conducted a meta-analysis of the relevant literature in accordance with PRISMA guidelines. We searched PubMed, Embase, Web of Science, and Google Scholar using “Subarachnoid hemorrhage AND frailty” and “subarachnoid hemorrhage AND frail” as search terms. Data on cohort age, frailty measurements, clinical grading systems, and post-treatment outcomes were extracted. Of 74 studies identified, four studies were included, with a total of 64,668 patients. Percent frailty was 30.4% under a random-effects model in all aSAH patients (p < 0.001). Overall mortality rate of aSAH patients was 11.7% when using a random-effects model (p < 0.001). There was no significant difference in mortality rate between frail and non-frail aSAH patients, but this analysis only included two studies and should be interpreted cautiously. Age and clinical grading, rather than frailty, independently predicted outcomes and mortality in aSAH patients.

Background and Objectives: Hypothyroidism affects 4.6% of the US population, with incidence increasing in recent years. Systemic effects of hypothyroidism include increased serum cholesterol, endothelial dysfunction, and hypertension, which are widely recognized risk factors for stroke. To better understand the prognostic value of thyroid hormone levels in acute ischemic stroke (AIS), this population-based, cross-sectional study aims to examine the clinical outcomes of patients with AIS with hypothyroidism. Methods: The National (Nationwide) Inpatient Sample was queried from 2016 to 2020 for patients with AIS with a diagnosis of hypothyroidism using International Classification of Disease Ninth and Tenth Revision diagnostic codes. patients with AIS with and without hypothyroidism were assessed for baseline clinical characteristics, interventions, complications, and clinical outcomes. Propensity score matched analysis (1:1) was conducted to control for possible confounding variables. Results: Of 2,946,195 patients with AIS identified, 388,235 (13.2%) had a concurrent diagnosis of hypothyroidism. After propensity-score matching, hypothyroidism patients were more likely to experience discharge home (odds ratio (OR) = 0.70; p < 0.01), shorter length of stay (LOS) (4.93 vs. 5.19 days; p < 0.01), and lower rates of inpatient death (OR = 0.80; 95% CI: 0.76–0.84; p < 0.01), compared to patients without hypothyroidism. Conclusions: This retrospective analysis found that patients with hypothyroidism had shorter inpatient LOS, improved discharge disposition, and lower rates of mortality, suggesting that low thyroid hormone levels may be protective in outcomes of AIS. With the rising prevalence of hypothyroidism in the US population, it is increasingly important to investigate its potential effects on patients with cerebrovascular disease.

Purpose: Obesity is associated with poor in-vitro fertilization (IVF) outcomes, with limited data on patients with BMI ≥ 40 kg/m ² . This study assessed BMI’s impact on frozen embryo transfer (FET) outcomes. Methods: A retrospective cohort study (2017–2024) of 1,424 FETs from 889 patients, stratified by BMI: normal (18.5–24.9), overweight (25.0–29.9), obese (30.0–39.9), morbidly obese (≥ 40). Primary outcome was live birth rate per transfer (LBR). Secondary outcomes include clinical intrauterine pregnancy (CIUPR), miscarriage rates (MR), and proportion achieving ≥ 1 live birth. Outcomes were adjusted for age, AMH, FSH, PCOS, tubal infertility, and race. Results: LBR decreased with increasing BMI for all transfers (53.5%, 52.8%, 42.5%, 30.8%, p < 0.001) and single elective euploid transfers (SEETs) (54.2%, 57.8%, 44.5%, 32.3%, p < 0.001). CIUPR showed the same pattern (58.0%, 59.5%, 50.4%, 39.7%; p < 0.001 all transfers; 58.6%, 63.1%, 51.0%, 40.3%; p < 0.001 SEETs), as did the proportion of patients achieving at least one birth (72.9%, 68.3%, 65.8%, 51.1%; p = 0.020). MR significantly increased with BMI (7.4%, 11.2%, 15.2%, 22.6%, p <0.001) for all transfers but not for SEETs (7.5%, 8.4%, 12.8%, 20.0%; p = 0.169). Each one-unit increase in BMI was associated with a 3% reduction in odds of live birth (aOR 0.969, 95% CI 0.951–0.987, p<0.001 ). Conclusion: Increasing BMI is associated with lower LBR and CIUPR, following FET, including SEETs. MR increased with BMI for all FETs, with a similar but non-significant gradient among SEETs. This highlights the importance of considering BMI when counseling patients, particularly those with morbid obesity.