How Does Frailty Impact Peri-Operative Cochlear Implantation Outcomes in Veterans?

Introduction: Frailty has been shown to impact various surgical outcomes among different disciplines. Our goal was to investigate how frailty influences post-cochlear implantation (CI) admission, morbidity, and outcomes in the veteran population.

Methods: A retrospective cohort study included patients who underwent CI at our single-institution tertiary care veterans’ affairs hospital between 1998 - 2024. The Modified 5-Item Frailty Index 5 (mFI-5) score was used to characterize patient frailty on a scale from 0 to 5 based on history of congestive heart failure, hypertension requiring medication, type 2 diabetes mellitus, chronic obstructive pulmonary disease, and functional independence. Outcomes of interest were post-CI admission rate, relationship between frailty and admission, and relationship between frailty and post-CI open-set word recognition (WRS). Ordinal and nominal data were analyzed via Fischer exact test and Spearman correlation, respectively. Significance was set at p< 0.05, r>0.25.

Results: Ninety-two patients underwent CI from 1998 – 2024, resulting in 39 (37.5%) admissions out of a possible 104 encounters. Admission rate initially increased from 2016 to 2020 (46.8%), then decreased (25.8%). Median age was 71 years (range 35 – 92 years). The majority (53%) of patients scored ≤ 1 on the mFI-5. While patients with less frailty were less readily admitted (33% for m-Fi5 ≤1 versus 43% for m-FI5 ≥2; RR 0.8, p=0.29) and had a lower rate of dizziness (13% for m-FI5≤1 versus 18% for m-FI5≥2; RR 0.7, p=0.6), these relationships were not significant. Frailty score was not significantly associated with 3-month post-CI WRS (r≤-0.25, p>0.05). Higher frailty score, however, was significantly correlated with lower AzBio sentence scores at 6 months post-CI (r=-0.44, 95% CI -0.66 to -0.15). CNC wordlist scores at 6 months showed a similar trend, but did not establish significance (r=-0.27, 95% CI -0.53 to 0.04).

Conclusions: Post-CI admission rate in our veteran population was surprisingly high, but is declining. Patient frailty may play a role in post-CI speech recognition, but did not appear to impact likelihood of admission.