Utility of hospital frailty risk score for predicting postoperative outcomes in craniopharyngioma

Peterson, Racheal; Kandregula, Sandeep; Jee, Elizabeth; Guthikonda, Bharat

doi:10.1007/s11060-022-04056-x

Cited by 15 publications

(8 citation statements)

References 30 publications

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“…"Frailty," as measured by HFRS, was commonly associated with prolonged length of stay (11/17 studies), 18,20,22,26,28,29,31,32,34,35 nonroutine discharge (10/17 studies), 18,20,22,26,28,31,32,[34][35][36] and increased hospital costs (9/17 studies). 18,20,22,27,28,31,[34][35][36] Conversely, few studies (1/17 studies) demonstrated evidence of HFRS as a predictor of worse quality of life, 23 functional outcomes, 24 reoperation, 35 or in-hospital mortality. 12 Recent Letters Have Questioned the Validity of HFRS Despite its widespread implementation, the validity of HFRS as a true measure of frailty has been repeatedly questioned.…”

Section: Discussionmentioning

confidence: 99%

“…26 In predicting postoperative outcomes in craniopharyngioma patients, HFRS was predictive of increased hospital length of stay and overall care costs. 27 Higher HFRS scores have also been associated with eLOS, higher hospital charges, and increased rates of nonroutine discharge and 90-day readmission in patients undergoing intracranial brain tumor resection. 28…”

Section: Hfrs In Cranial Neurosurgerymentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Hfrs In Cranial Neurosurgerymentioning

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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“…8 Furthermore, the inclusion of acute disease severity measures (eg, acute hip fracture, head injury, and acute myocardial infarction) into frailty indices severely hinders clinical generalizability to neurosurgical patient populations, particularly to those in the outpatient clinics, and obfuscates the entire concept of frailty screening for preoperative decisionmaking. [9][10][11][12][13][14][15] To address these concerns, the authors encourage continued research and evaluation of existing frailty metrics to establish a consensus with a standardized, validated, and easy-touse index. The Risk Analysis Index (RAI) is a robust frailty index originally developed and validated in surgical populations.…”

mentioning

confidence: 99%

Frailty Measured by the Risk Analysis Index Predicts Nonhome Discharge and Mortality After Resection in Refractory Epilepsy: Analysis of 1236 Patients From a Prospective Surgical Registry, 2012 to 2020

et al. 2023

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BACKGROUND: Risk stratification of epilepsy surgery patients remains difficult. The Risk Analysis Index (RAI) is a frailty measurement that augments preoperative risk stratification. OBJECTIVE: To evaluate RAI's discriminative threshold for nonhome discharge disposition (NHD) and mortality (or discharge to hospice within 30 days of operation) in epilepsy surgery patients. METHODS: Patients were queried from the American College of Surgeons-National Surgical Quality Improvement Program database (2012-2020) using diagnosis/procedure codes. Linear-by-linear trend tests assessed RAI's relationship with NHD and mortality. Discriminatory accuracy was assessed by C-statistics (95% CI) in receiver operating characteristic curve analysis. RESULTS: Epilepsy resections (N = 1236) were grouped into temporal lobe (60.4%, N = 747) and nontemporal lobe (39.6%, N = 489) procedures. Patients were stratified by RAI tier: 76.5% robust (RAI 0-20), 16.2% normal (RAI 21-30), 6.6% frail (RAI 31-40), and 0.8% severely frail (RAI 41 and above). The NHD rate was 18.0% (N = 222) and positively associated with increasing RAI tier: 12.5% robust, 34.0% normal, 38.3% frail, and 50.0% severely frail (P < .001). RAI had robust predictive discrimination for NHD in overall cohort (C-statistic 0.71), temporal lobe (C-statistic 0.70), and nontemporal lobe (C-statistic 0.71) cohorts. The mortality rate was 2.7% (N = 33) and significantly associated with RAI frailty: 1.1% robust, 8.0% normal, 6.2% frail, and 20.0% severely frail (P < .001). RAI had excellent predictive discrimination for mortality in overall cohort (C-statistic 0.78), temporal lobe (C-statistic 0.80), and nontemporal lobe (C-statistic 0.74) cohorts. CONCLUSION: The RAI frailty score predicts mortality and NHD after epilepsy surgery. This is accomplished with a user-friendly calculator: https://nsgyfrailtyoutcomeslab.shinyapps.io/epilepsy/.

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“…They found that these studies had a consensus in reporting that HFRS was predictive of postoperative mortality, complications, extended length of stay, and discharge to a higher level of care facility (skilled nursing facility). [7][8][9][10] The paper highlights that HFRS has not been adequately validated for surgical patient populations, especially for those younger than 75 years. This raises concerns about its accuracy in assessing frailty in the context of preoperative individual risk stratification.…”

mentioning

confidence: 99%

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

Dagra,

Rezk,

Lucke-Wold

2023

Neurosurgery

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Utility of hospital frailty risk score for predicting postoperative outcomes in craniopharyngioma

Cited by 15 publications

References 30 publications

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

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

Frailty Measured by the Risk Analysis Index Predicts Nonhome Discharge and Mortality After Resection in Refractory Epilepsy: Analysis of 1236 Patients From a Prospective Surgical Registry, 2012 to 2020

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

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