The Frailty Risk Score predicts length of stay and need for rehospitalization after kidney transplantation in a retrospective cohort: a pilot study

Abstract

BackgroundFrailty is a widely used measure in older patients as a predictor of poor outcomes after hospitalization and surgery. There is a growing body of data in kidney transplantation suggesting frailty can predict adverse outcomes. There is interest in using chart review measures of frailty and multimorbidity, as they may be equally predictive as physical measurement. This approach holds promise for patient evaluation, identifying candidates for prehabilitation, and targeting resources towards those anticipated to have an increased rate of clinical challenges after kidney transplantation. Frail patients who are often older may place a large resource and economic burden on transplant programs.MethodsWe applied a previously published chart review–based approach in a retrospective, pilot study to calculate the Frailty Risk Score (FRS) utilizing a cohort of kidney transplant patients. We reviewed concurrent comorbidities using the Charlson comorbidity (CM) score to determine the feasibility and utility of applying this approach in transplant patients to predict post-transplant outcomes such as length of hospitalization and the need for rehospitalization.ResultsSixty kidney transplant recipients were evaluated by chart review, 23 characterized as older (> = 60) and 37 younger (ages 30–59). Median FRS score was 3 (range 1–7). Higher FRS was significantly associated with increased patient age (high FRS 19% in younger patients, 43% in older patients). Increased CM score was also associated with increased patient age. Patients with a high FRS stayed in the hospital for an average of 8 days, compared with 5.7 days for a low FRS. Patients with high FRS were readmitted an average of 2.9 times compared with an average of 1.1 for those with a low FRS. FRS score remained significant for predicting outcomes after adjustment for patient age.ConclusionElevated FRS prior to transplantation was associated with increased hospital stay and the need for readmission in kidney transplant recipients. This analysis demonstrates the potential strength of chart review in evaluating frailty prior to transplantation, permitting risk stratification and targeting of resources for rehabilitation and close post-transplant monitoring. Frail patients may benefit from targeted “prehabilitation” to attenuate the associated adverse clinical outcomes.

Cardiometabolic diseases, frailty, and healthcare utilization and expenditure in community-dwelling Chinese older adults

“…Jankovic et al 31 observed that an increased number of non-communicable diseases was significantly associated with a higher utilization of health care services, including general practitioner, inhospitalization and length of stay, in Serbia. However, these studies have not considered the healthcare effects of frailty as described recently 24 , 25 , 32 , and some subjects were middle-aged adults. No studies have investigated the association between cardiometabolic diseases and healthcare utilization after adjusting for frailty.…”

“…However, there is considerable individual variability in healthcare expenditure and utilization in aged populations and current multimorbidity measures have only a modest predictive validity for total healthcare expenditure 23 . Several studies have shown that frailty was associated with higher subsequent total healthcare expenditure and utilization after accounting for multimorbidity 24 , 25 . Hence, timely identification of frailty is important to stratify the healthcare utilization and expenditure among older adults.…”

Donor type and 3-month hospital readmission following kidney transplantation: results from the Netherlands Organ Transplant Registry

“…Elderly patients are more likely to be comorbid compared to their younger counterparts at the time of kidney transplantation (48.2% in elderly KTRs and 28.9% in young patients) [22], and frailty is also highly prevalent in elderly patients receiving renal replacement therapy. [23] The explanation is furthermore supported by a study suggesting that frailty at the time of kidney transplantationevaluated as unintentional weight loss, weakness, exhaustion, low activity, and slowed walking speedindependently predicts a 60% higher risk of readmission. [24] Finally, our study suggested comparability in the risk of 3-month hospital readmission in KTRs with DBD and DCD donors, regardless of age.…”

Frailty and the Potential Kidney Transplant Recipient: Time for a More Holistic Assessment?

“…Simpler measures, such as walking speed or the Timed Up and Go Test, do not seem be as good of a predictor of outcomes (44,45). Schaenman et al (46) performed a pilot study evaluating the feasibility and utility of a simple chart review-based Frailty Risk Score (FRS) to predict post-transplant outcomes. Their pilot study demonstrated that the FRS is a feasible approach and the preliminary results suggested that the FRS may be able to predict hospital length of stay and rehospitalization risk after operation (46).…”

“…Schaenman et al (46) performed a pilot study evaluating the feasibility and utility of a simple chart review-based Frailty Risk Score (FRS) to predict post-transplant outcomes. Their pilot study demonstrated that the FRS is a feasible approach and the preliminary results suggested that the FRS may be able to predict hospital length of stay and rehospitalization risk after operation (46). The FRS requires further evaluation before it can be recommended for use in clinical practice.…”