Background/Objectives: Nonacute subdural hematomas (naSDHs) are a prevalent intracranial pathology, particularly in older people, due to increased brain atrophy, fall risk, and anticoagulant use. This study examines the impact of frailty on the surgical outcomes of craniotomy for naSDH over 20 years. Methods: Data from the Nationwide Inpatient Sample (NIS) from 2000 to 2021 were analyzed, including 251,597 patients who underwent cranial decompression for naSDH. Patients were selected using specific ICD codes. Frailty was calculated using the modified frailty index (mFI-5 and mFI-11) and the Charlson Comorbidity Index (CCI). Outcomes were compared using descriptive statistics and multivariable regression models. Results: 251,597 patients underwent craniotomy, with a mean age of 69.2 years. The cohort exhibited significant comorbid conditions, reflected in a mean Charlson Comorbidity Index (CCI) of 3.8, and a high frailty prevalence, with 23.49% of patients classified as frail and 20.14% as severely frail. The CCI demonstrated the highest predictive value for adverse outcomes, with an area under the curve (AUC) of 0.6346 for mortality and 0.6804 for complications. Frailty indices (mFI-5 and mFI-11) were also strongly associated with increased mortality (p < 0.001), complications (p < 0.001), and extended length of stay (p < 0.001). Age was not a significant predictor of outcomes. Conclusions: This study highlights the moderate impact of frailty on surgical outcomes for naSDH.

Introduction: Large vessel occlusion (LVO) strokes are a significant cause of disability and death globally. Endovascular mechanical thrombectomy (EVT) has improved outcomes for LVO patients. However, the impact of pre-existing frailty on outcomes for patients undergoing EVT remains understudied. Methods: This study utilized the National Inpatient Sample (NIS) database to identify patients aged 18 and older who underwent EVT for LVO of the internal carotid artery (ICA) or middle cerebral artery (MCA) from 2016 to 2021. Frailty was assessed using the modified Frailty Index-5 (mFI-5), mFI-11, Charlson Comorbidity Index (CCI), and Risk Analysis Index (RAI). Outcomes analyzed included mortality, complications, length of stay (LOS), discharge disposition, and cost of care. Results: We analyzed 57,260 EVT admissions. Patients classified as highly frail by the CCI had the highest in-hospital mortality (odds ratio (OR) 1.13, p < 0.0001). High frailty identified by mFI-5 was associated with a higher likelihood of postoperative complications (OR 1.41, p < 0.0001) and extended LOS (OR 1.23, p < 0.0001). High frailty by the administrative RAI was linked to nonhome discharge (OR 1.31, p < 0.0001), with mFI-5 showing similar predictive value (OR 1.30, p < 0.0001). High frailty, as determined by the CCI, incurred the highest estimated cost of care (p < 0.0001). Conclusions: Frailty assessment using mFI-5 is a practical predictor of patient outcomes in LVO thrombectomy, including complication rates, extended LOS, and discharge disposition. The CCI remains the most predictive for mortality, though it is more complex to calculate. We emphasize that frailty, as measured by the mFI-5, is one of many factors to consider when deciding on EVT for LVO.

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