Frailty and Nutritional Status as Predictors of 30-Day Postoperative Outcomes in Pituitary Tumor Surgery: A Retrospective Analysis of 1,870 ACS-NSQIP Patients

Current classification systems for pituitary adenomas do not adequately account for patient-specific physiologic factors such as frailty and nutritional status, which may be important for preoperative risk stratification beyond tumor characteristics. In this retrospective cohort study of 1,870 patients undergoing pituitary surgery, frailty indices, including the Risk Analysis Index (RAI) and modified Frailty Index-5 (mFI-5), as well as nutritional assessment using the Geriatric Nutritional Risk Index (GNRI), were evaluated as predictors of 30-day postoperative outcomes. Frailty and nutritional risk were significantly associated with adverse postoperative outcomes, while the combined Comorbidity-Adjusted Risk Profile (CGARP) demonstrated superior predictive performance across multiple outcome measures. These findings suggest that patient physiologic factors complement traditional tumor-based risk stratification and may improve preoperative counseling, perioperative planning, and risk-adjusted outcome reporting in pituitary surgery.