How does Frailty Impact Peri-Operative and Speech Recognition Outcomes for Cochlear Implants in Veterans?

OBJECTIVE

To investigate the association of frailty with post-cochlear implant (CI) admission, morbidity, and CI-aided word recognition outcomes in veterans.

STUDY

DESIGN

Retrospective cohort.

SETTING

Single-institution tertiary care Veterans Health Administration (VHA) hospital.

METHODS

Veterans who underwent cochlear implantation between 1998 to 2024 were included. The Modified 5-Item Frailty Index (mFI-5) score was used to characterize preoperative frailty. Outcomes of interest were admission from post-anesthesia care unit (PACU), relative risk (RR) of admission among frail patients, and relationship between frailty and post-CI word recognition score (WRS). Ordinal data were analyzed via logistic regression and Chi square tests; a multivariate linear regression was used to assess nominal data. Significance was set at P < .05.

RESULTS

Ninety-one patients (median age 71 years, range 35-92 years) resulted in 41 (39.4%) admissions out of 104 surgical encounters. Admission rate initially increased from 2016 to 2020 (48.9%), then decreased (29%) in 2021. Forty-two (46%) patients met criteria as being frail, while 26 (28.6%) were prefrail. While frail patients were more readily admitted (43% vs 36%; RR 1.15) and had higher rates of dizziness (20% vs 15%; RR 1.23) when compared to the combined cohort of nonfrail and prefrail patients, these relationships were not significant. Preoperative frailty was significantly negatively associated with post-CI WRS at 6- and 12-month post-CI in a multivariate analysis including patient age (P < .05).

CONCLUSION

The prevalence of frailty is high among veterans undergoing cochlear implantation. Patient frailty is significantly associated with post-CI speech recognition but did not appear to impact likelihood of admission or complications.