A Frailty-integrated Prognostic Prediction Tool for Long-term Outcomes after Shunt Surgery in Idiopathic Normal Pressure Hydrocephalus: Development and Prospective Validation
6 affiliations
- 1Department of Stroke Medicine and Neurosurgery, Japanese Red Cross Kitami Hospital and Okhotsk Stroke Medical Center, Kitami, Hokkaido, Japan
- 2Department of Neurosurgery, Dohtoh Neurosurgery Hospital, Kitami, Hokkaido, Japan
- 3Information Design and Communication Course, Kitami Institute of Technology, Kitami, Hokkaido, Japan
- 4Department of Neurosurgery, Nagoya City University Graduate School of Medical Science, Nagoya, Aichi, Japan
- 5Department of Neurosurgery, Nayoro General Hospital, Nayoro, Hokkaido, Japan
- 6Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
Abstract
Long-term functional independence after shunt surgery for idiopathic normal pressure hydrocephalus varies widely, particularly in older patients with multiple comorbidities. We aimed to develop and prospectively validate a frailty-integrated prognostic prediction tool to support patient selection and preoperative decision-making. A retrospective cohort of 82 patients with idiopathic normal pressure hydrocephalus who underwent shunt surgery between 2005 and 2014 was used to develop a weighted idiopathic normal pressure hydrocephalus–specific frailty index based on multivariable logistic regression. The index incorporated neurological and non-neurological comorbidities, including dementia, cancer, depression, and movement disorders. The weighted idiopathic normal pressure hydrocephalus–specific frailty index was combined with preoperative modified Rankin Scale scores to estimate the probability of achieving functional independence (modified Rankin Scale ≤2) at 1, 2, and mid- to long-term follow-up (up to 4 years). Prospective validation was performed in an independent cohort of 30 patients treated between 2018 and 2023. The weighted idiopathic normal pressure hydrocephalus–specific frailty index demonstrated improved predictive performance, particularly for mid- to long-term outcomes (2-4 years), compared with conventional frailty indices, with higher correlation coefficients and lower Akaike Information Criterion values. Predicted probabilities of long-term independence declined stepwise with increasing frailty burden. In the validation cohort, predicted and observed outcomes showed good agreement, with adequate calibration confirmed by the Hosmer–Lemeshow test. This frailty-integrated prognostic prediction tool provides individualized estimates of long-term postoperative independence, particularly in the context of frailty and comorbidity burden. By incorporating comorbidity burden into preoperative assessment, the tool supports patient selection and shared decision-making and may facilitate realistic counseling and long-term care planning in older patients.
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BibTeX
@article{kimura2026frailtyintegrated,
title = {{A Frailty-integrated Prognostic Prediction Tool for Long-term Outcomes after Shunt Surgery in Idiopathic Normal Pressure Hydrocephalus: Development and Prospective Validation}},
author = {Teruo KIMURA and Atsushi NAKAGAKI and Takahiro SANADA and Hirotaka SATO and Seiya FUJIKAWA and Yujiro MATSUSHIMA and Anna ARAKI and Shigeki YAMADA and Kazuhiro SAKO and Manabu KINOSHITA},
journal = {Neurologia medico-chirurgica},
year = {2026},
month = aug,
doi = {10.2176/jns-nmc.2026-0066},
url = {https://doi.org/10.2176/jns-nmc.2026-0066},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - A Frailty-integrated Prognostic Prediction Tool for Long-term Outcomes after Shunt Surgery in Idiopathic Normal Pressure Hydrocephalus: Development and Prospective Validation
AU - Teruo KIMURA
AU - Atsushi NAKAGAKI
AU - Takahiro SANADA
AU - Hirotaka SATO
AU - Seiya FUJIKAWA
AU - Yujiro MATSUSHIMA
AU - Anna ARAKI
AU - Shigeki YAMADA
AU - Kazuhiro SAKO
AU - Manabu KINOSHITA
PY - 2026
DA - 2026/08/07
JO - Neurologia medico-chirurgica
DO - 10.2176/jns-nmc.2026-0066
UR - https://doi.org/10.2176/jns-nmc.2026-0066
AB - Long-term functional independence after shunt surgery for idiopathic normal pressure hydrocephalus varies widely, particularly in older patients with multiple comorbidities. We aimed to develop and prospectively validate a frailty-integrated prognostic prediction tool to support patient selection and preoperative decision-making. A retrospective cohort of 82 patients with idiopathic normal pressure hydrocephalus who underwent shunt surgery between 2005 and 2014 was used to develop a weighted idiopathic normal pressure hydrocephalus–specific frailty index based on multivariable logistic regression. The index incorporated neurological and non-neurological comorbidities, including dementia, cancer, depression, and movement disorders. The weighted idiopathic normal pressure hydrocephalus–specific frailty index was combined with preoperative modified Rankin Scale scores to estimate the probability of achieving functional independence (modified Rankin Scale ≤2) at 1, 2, and mid- to long-term follow-up (up to 4 years). Prospective validation was performed in an independent cohort of 30 patients treated between 2018 and 2023. The weighted idiopathic normal pressure hydrocephalus–specific frailty index demonstrated improved predictive performance, particularly for mid- to long-term outcomes (2-4 years), compared with conventional frailty indices, with higher correlation coefficients and lower Akaike Information Criterion values. Predicted probabilities of long-term independence declined stepwise with increasing frailty burden. In the validation cohort, predicted and observed outcomes showed good agreement, with adequate calibration confirmed by the Hosmer–Lemeshow test. This frailty-integrated prognostic prediction tool provides individualized estimates of long-term postoperative independence, particularly in the context of frailty and comorbidity burden. By incorporating comorbidity burden into preoperative assessment, the tool supports patient selection and shared decision-making and may facilitate realistic counseling and long-term care planning in older patients.
SN - 0470-8105
SN - 1349-8029
ER -