Die Bedeutung der Gebrechlichkeit bei neurochirurgisch behandelbaren Erkrankungen der peripheren Nerven: eine landesweite Beobachtungsstudie aus einem großen Krankenhausverbund

In many neurosurgically treatable diseases, frailty is associated with pronounced disease progression and poorer treatment outcomes. The COVID-19 pandemic led to an increase in frailty among the general population. The impact of frailty on neurosurgically treatable diseases of peripheral nerves (PN) has never been studied before. Our study presents the first German-wide analysis of the impact of frailty on patients with four diseases of PN: Meralgia paresthetica (MP), benign nerve tumors (BNT), lesions of the brachial plexus (BP), and ulnar neuropathy (UN).

Administrative Data from a German-wide network of 76 hospitals was retrospectively analyzed comparing the prepandemic (January 1, 2016 – December 31, 2019) vs. the pandemic phase (January 1, 2020 – December 31, 2022). Patients hospitalized for MP (G57.1), BNT (D36.1), lesions of BP (G54.0), and UN (G66.2) were included. Frailty was categorized according to the Hospital Frailty Risk Score (HFRS), as follows: low (HFRS <5 points), medium (5-15 points), and high (>15 points). Ethical approval was granted by the local ethics comittee (490/20-ek).

A total of 8,992 patients were included in the study (prepandemic n=5,918, pandemic n=3,074). Daily admission rates decreased during the pandemic among all of the four entities: MP (0.6 to 0.3 [p<0.01], BNT (0.8 to 0.7, [p=0.05]), lesion of BP (0.9 to 0.7 [p<0.01]), and UN (1.9 to 1.2 [p<0.01], respectively. For MP, the rate of patients with medium frailty increased from 16.5 to 26.7% (p<0.01) during the pandemic phase compared with the prepandemic phase. Concordantly, the rates of patients with low frailty decreased from 82.2 to 71.0% (p=0.3). For BNT, lesion of BP, and UN, the overall rate of frail patients were lower and no change of HFRS between the pre- and pandemic phase were observed. Type of surgery did not change comparing the two phases. A reduction in length of hospital stay between pre- and pandemic phase was observed for BNT (4.6 ±4.7 vs. 3.7 ±3.4 days [p<0.01]), for lesions of BP (4.5 ±4.3 vs. 5.1 ±4.0 days [p>0.01], and for UN (2.4 ±2.3 vs. 1.9 ±3.4 days [p<0.01]).

Daily admission rates of patients with PN diseases decreased during the COVID-19 pandemic in Germany. Among these, MP patients had the highest frailty scores with an increase during the pandemic phase. In all entities but MP, the pandemic led to a reduction in lenght of hospital stay. Our data shows for the first time, that frailty has an impact on patients treated for MP.