Response to Correspondence re ‘Predicting outcomes in older patients undergoing vascular surgery using the Hospital Frailty Risk Score’ by Guijuri et al

Aitken, Sarah; Lujic, Sanja; Randall, Deborah; Noguchi, Naomi; Naganathan, Vasi; Blyth, Fiona

doi:10.1093/bjs/znaa135

Cited by 14 publications

(24 citation statements)

References 1 publication

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“…Similarly, Hannah et al showed that HFRS was associated with longer lengths of stay and higher risk of intensive care unit stays after spine surgery [17]. HFRS has also been validated as a predictor of postoperative events in hospitalizations for inflammatory bowel disease and after vascular surgery [13,18].…”

Section: Discussionmentioning

confidence: 98%

Frailty Is Associated With Increased 30-Day Adverse Events and Hospitalization Costs After Primary Total Hip Arthroplasty

Tram

O’Connor

Qian

et al. 2022

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 98%

Frailty Is Associated With Increased 30-Day Adverse Events and Hospitalization Costs After Primary Total Hip Arthroplasty

Tram

O’Connor

Qian

et al. 2022

The Journal of Arthroplasty

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“…Since the development and validation of the hospital frailty risk score in the acute care setting [ 9 ], the association between HFRS score and adverse events has been replicated in numerous in-patient [ 11 – 14 ] and procedural settings [ 15 – 17 ]. In the peri-operative setting, higher HFRS scores have been associated with adverse events in patients undergoing spinal surgery [ 18 ], joint arthroplasty [ 19 ], vascular surgery [ 20 ] and cirrhotic patients undergoing surgery [ 21 ]. In a generalizable cohort of 487,197 patients over the age of 50 undergoing surgery Harvey et al demonstrated that a high HFRS was associated with prolonged length of stay, 30-day mortality and 28-day readmission [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Beyond the revised cardiac risk index: Validation of the hospital frailty risk score in non-cardiac surgery

et al. 2022

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Frailty is an established risk factor for adverse outcomes following non-cardiac surgery. The Hospital Frailty Risk Score (HFRS) is a recently described frailty assessment tool that harnesses administrative data and is composed of 109 International Classification of Disease variables. We aimed to examine the incremental prognostic utility of the HFRS in a generalizable surgical population. Using linked administrative databases, a retrospective cohort of patients admitted for non-cardiac surgery between October 1st, 2008 and September 30th, 2019 in Alberta, Canada was created. Our primary outcome was a composite of death, myocardial infarction or cardiac arrest at 30-days. Multivariable logistic regression was undertaken to assess the impact of HFRS on outcomes after adjusting for age, sex, components of the Charlson Comorbidity Index (CCI), Revised Cardiac Risk Index (RCRI) and peri-operative biomarkers. The final cohort consisted of 712,808 non-cardiac surgeries, of which 55·1% were female and the average age was 53·4 +/- 22·4 years. Using the HFRS, 86.3% were considered low risk, 10·7% were considered intermediate risk and 3·1% were considered high risk for frailty. Intermediate and high HFRS scores were associated with increased risk of the primary outcome with an adjusted odds ratio of 1·61 (95% CI 1·50–1.74) and 1·55 (95% CI 1·38–1·73). Intermediate and high HFRS were also associated with increased adjusted odds of prolonged hospital stay, in-hospital mortality, and 1-year mortality. The HFRS is a minimally onerous frailty assessment tool that can complement perioperative risk stratification in identifying patients at high risk of short- and long-term adverse events.

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“…Frailty was defined using the HFRS, a validated ICD-10 coding algorithm developed by Gilbert et al 17 and used in multiple studies. [19][20][21][22][23][24][25] The coding algorithm is derived from a cluster of frail individuals with 109 over-represented ICD-10 codes assigned a number of points ranging from 0.1 to 7.1 reflecting the strength of association to the frail cluster. 17 These points are added together for a final frailty risk score.…”

Section: Hospital Frailty Risk Score (Hfrs)mentioning

confidence: 99%

Higher Hospital Frailty Risk Score is associated with increased complications and healthcare resource utilization after endovascular treatment of ruptured intracranial aneurysms

Koo

Elsamadicy

Renedo

et al. 2022

J NeuroIntervent Surg

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AimTo use the Hospital Frailty Risk Score (HFRS) to investigate the impact of frailty on complication rates and healthcare resource utilization in patients who underwent endovascular treatment of ruptured intracranial aneurysms (IAs).MethodsA retrospective cohort study was performed using the 2016–2019 National Inpatient Sample database. All adult patients (≥18 years) undergoing endovascular treatment for IAs after subarachnoid hemorrhage were identified using ICD-10-CM codes. Patients were categorized into frailty cohorts: low (HFRS <5), intermediate (HFRS 5–15) and high (HFRS >15). Patient demographics, adverse events, length of stay (LOS), discharge disposition, and total cost of admission were assessed. Multivariate logistic regression analysis was used to identify independent predictors of prolonged LOS, increased cost, and non-routine discharge.ResultsOf the 33 840 patients identified, 7940 (23.5%) were found to be low, 20 075 (59.3%) intermediate and 5825 (17.2%) high frailty by HFRS criteria. The rate of encountering any adverse event was significantly greater in the higher frailty cohorts (low: 59.9%; intermediate: 92.4%; high: 99.2%, p<0.001). There was a stepwise increase in mean LOS (low: 11.7±8.2 days; intermediate: 18.7±14.1 days; high: 26.6±20.1 days, p<0.001), mean total hospital cost (low: $62 888±37 757; intermediate: $99 670±63 446; high: $134 937±80 331, p<0.001), and non-routine discharge (low: 17.3%; intermediate: 44.4%; high: 69.4%, p<0.001) with increasing frailty. On multivariate regression analysis, a similar stepwise impact was found in prolonged LOS (intermediate: OR 2.38, p<0.001; high: OR 4.49, p<0.001)], total hospital cost (intermediate: OR 2.15, p<0.001; high: OR 3.62, p<0.001), and non-routine discharge (intermediate: OR 2.13, p<0.001; high: OR 4.17, p<0.001).ConclusionsOur study found that greater frailty as defined by the HFRS was associated with increased complications, LOS, total costs, and non-routine discharge.

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Response to Correspondence re ‘Predicting outcomes in older patients undergoing vascular surgery using the Hospital Frailty Risk Score’ by Guijuri et al

Cited by 14 publications

References 1 publication

Frailty Is Associated With Increased 30-Day Adverse Events and Hospitalization Costs After Primary Total Hip Arthroplasty

Frailty Is Associated With Increased 30-Day Adverse Events and Hospitalization Costs After Primary Total Hip Arthroplasty

Beyond the revised cardiac risk index: Validation of the hospital frailty risk score in non-cardiac surgery

Higher Hospital Frailty Risk Score is associated with increased complications and healthcare resource utilization after endovascular treatment of ruptured intracranial aneurysms

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