Hospital frailty risk score predicts adverse events in spine surgery

Quintana, Loreto Pulido; Meyer, M.; Reinhard, Jan; Kappenschneider, Tobias; Grifka, Joachim; Weber, Markus

doi:10.1007/s00586-022-07211-0

Cited by 14 publications

(7 citation statements)

References 40 publications

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“…24,30,31 A newer metric is the hospital frailty risk score (HFRS), developed using International Classi cation of Diseases, Tenth Revision (ICD-10) codes for medical conditions highly represented in a cohort of elderly patients. 32 The HFRS has previously been shown to be predictive in assessing adverse outcomes following degenerative spinal surgery, 33,34 and surgery for metastatic spinal column tumors. 7 However, there is a paucity of data investigating the predictive value of increased HFRS on outcomes in patients undergoing surgery for spinal meningiomas.…”

Section: Introductionmentioning

confidence: 99%

Association of Frailty Risk with Hospital Outcomes after Surgical Resection for Benign and Malignant Spinal Meningiomas

Elsamadicy

Koo

Reeves

et al. 2022

Preprint

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OBJECTIVE The Hospital Frailty Risk Score (HFRS) is a metric used to assess patient frailty risk in large national datasets using International Classification of Diseases, Tenth Revision (ICD-10) codes. While previous studies have assessed the association between frailty risk and postoperative outcomes in spine oncology, there is a paucity of data on the relationship between frailty risk and outcomes in patients undergoing surgery for spinal meningiomas. The goal of this study was to investigate the association between HFRS and hospital length of stay (LOS), discharge disposition, and cost of admission in patients undergoing surgery for spinal meningiomas. METHODS A retrospective cohort study was performed using the National Inpatient Sample Database from 2016 to 2019. Adult patients with benign or malignant spine meningiomas, identified using ICD-10 diagnostic and procedural coding, were stratified by HFRS: Low (HFRS < 5) and Intermediate-High (HFRS ≥ 5). These cohorts were further stratified by patient sex. Patient demographics, treating hospital characteristics, comorbidities, intraoperative variables, perioperative adverse events (AEs), LOS, discharge disposition, and cost of admission were assessed. Logistic multivariate regression analyses were performed to identify the associations between increased HFRS and LOS, discharge disposition, and cost in male and female patients. RESULTS Of the 3,345 study patients, 530 (15.8%) had Intermediate-High Frailty. Of the 530 Intermediate-High risk patients, 410 (77.4%) were female and of the 2,815 Low risk patients, 2,185 (77.6%) were female. The Intermediate-High cohort was significantly older (Low: 60.94±14.63 years vs Intermediate-High: 66.93±14.23 years, p < 0.001). A greater proportion of patients in the Intermediate-High cohort had three or more comorbidities (Low: 32.5% vs Intermediate-High: 74.5%, p < 0.001). Additionally, a greater proportion of patients in the Intermediate-High cohort experienced one or more perioperative AEs (Low: 7.1% vs Intermediate-High: 14.2, p = 0.018). Intermediate-High patients had longer mean LOS (Low: 4.02±2.30 days vs Intermediate-High: 7.14±6.03 days, p < 0.001) and higher mean total costs (Low: $24,344±$16,743 vs Intermediate-High: $37,013±$27,547, p < 0.001). Furthermore, a greater proportion of Intermediate-High patients had non-routine discharges (Low: 27.9% vs Intermediate-High: 55.7%, p < 0.001). On multivariate analysis, increased HFRS scores (≥ 5) were significantly associated with extended LOS (p < 0.001), non-routine discharge (p = 0.006), and increased costs (p = 0.004). CONCLUSION Our study shows that increased HFRS-defined frailty risk is significantly associated with extended LOS, non-routine discharge disposition, and increased costs in patients undergoing surgery for spine meningiomas. Further studies on the implications of frailty in these patients are merited in order to improve patient outcomes and healthcare resource utilization.

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Section: Introductionmentioning

confidence: 99%

Association of Frailty Risk with Hospital Outcomes after Surgical Resection for Benign and Malignant Spinal Meningiomas

Elsamadicy

Koo

Reeves

et al. 2022

Preprint

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“…12 HFRS has also shown satisfactory predictive ability in general spine surgery, with higher frailty being demonstrated as an independent risk factor of reoperation, surgical site infection, internal complications, Clavien-Dindo IV complications, and transfusion. 33…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, Gilbert et al wrote “the assessment of frailty should also inform processes of planning service provision and resource allocation.” 6 In the 17 neurosurgical studies, HFRS has only been used as a retrospective computer statistical exercise, with countless suggestions toward informing personalized care. 22,28,33,34 HFRS' application to inform personalized care is incorrect and may pose avoidable risk for patients.…”

Section: Discussionmentioning

confidence: 99%

The Limited Utility of the Hospital Frailty Risk Score as a Frailty Assessment Tool in Neurosurgery: A Systematic Review

Covell,

Roy,

Rumalla

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: The Hospital Frailty Risk Score (HFRS) is an International Classification of Disease 10th Revision-based scale that was originally designed for, and validated in, the assessment of patients 75 years or older presenting in an acute care setting. This study highlights central tenets inherent to the concept of frailty; questions the logic behind, and utility of, HFRS' recent implementation in the neurosurgical literature; and discusses why there is no useful role for HFRS as a frailty-based neurosurgical risk assessment (FBNRA) tool. METHODS: The authors performed a systematic review of the literature per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including all cranial and spinal studies that used HFRS as their primary frailty tool. Seventeen (N = 17) studies used HFRS to assess frailty's impact on neurosurgical outcomes. Thirteen total journals, 10 of which were neurosurgical journals, including the highest impact factor journals, published the 17 papers. RESULTS: Increasing HFRS score was associated with adverse outcomes, including prolonged length of stay (11 of 17 studies), nonroutine discharge (10 of 17 studies), and increased hospital costs (9 of 17 studies). Four different HFRS studies, of the 17, predicted one of the following 4 adverse outcomes: worse quality of life, worse functional outcomes, reoperation, or in-hospital mortality. CONCLUSION: Despite its rapid acceptance and widespread proliferation through the leading neurosurgical journals, HFRS lacks any conceptual relationship to the frailty syndrome or FBNRA for individual patients. HFRS measures acute conditions using International Classification of Disease 10th Revision codes and awards “frailty” points for symptoms and examination findings unrelated to the impaired baseline physiological reserve inherent to the very definition of frailty. HFRS lacks clinical utility as it cannot be deployed point-of-care at the bedside to risk stratify patients. HFRS has never been validated in any patient population younger than 75 years or in any nonacute care setting. We recommend HFRS be discontinued as an individual FBNRA tool.

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“…In this interesting study from Bad Abbach (Germany) , the individual patients’ risk due to the substantial biological differences in people of the same age has been investigated using the Hospital Frailty Risk Score (HFRS). 1 In this retrospective study, 2,042 patients who underwent lumbar decompression or fusion had their HFRS calculated using International Classification of Diseases (ICD)-10 codes entered at admission and from previous stays. The authors then classified frailty level into three risk categories: low HFRS, under five points; intermediate HFRS, five to 15 points; and high HFRS, above 15 points.…”

Section: Hospital Frailty Risk Score Predicts Adverse Events In Spine...mentioning

confidence: 99%

Spine

2022

Bone & Joint 360

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Hospital frailty risk score predicts adverse events in spine surgery

Cited by 14 publications

References 40 publications

Association of Frailty Risk with Hospital Outcomes after Surgical Resection for Benign and Malignant Spinal Meningiomas

Association of Frailty Risk with Hospital Outcomes after Surgical Resection for Benign and Malignant Spinal Meningiomas

The Limited Utility of the Hospital Frailty Risk Score as a Frailty Assessment Tool in Neurosurgery: A Systematic Review

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