Resident Physician Yale School of Medicine New Haven, Connecticut, United States
Introduction: The Hospital Frailty Risk Score (HFRS) is a frailty-identifying metric developed using ICD-10-CM diagnostic codes. The aim of this study was to examine the impact of HFRS-defined frailty on outcomes in adult spinal deformity (ASD) patients undergoing posterior spinal fusion (PSF).
Methods: A retrospective cohort study was performed using the 2016-2019 National Inpatient Sample database. Adults with ASD undergoing elective PSF were identified using ICD-10-CM codes. Patients were categorized into HFRS-based frailty cohorts: Low (HFRS < 5) and Intermediate-High (HFRS≥5). Patient demographics, comorbidities, intraoperative variables, outcomes, and healthcare resource utilization were assessed. Multivariate regression analyses were used to identify whether HFRS independently predicted extended LOS, non-routine discharge (NRD), and increased cost.
Results: Of the 7,500 patients identified, 4,000 (53.3%) were in the Low HFRS cohort and 3,500 (46.7%) were in the Intermediate-High HFRS cohort. Age increased with increasing frailty scores (p < 0.001). The Intermediate-High cohort had a greater comorbidity burden (p < 0.001), experienced more postoperative adverse events (p < 0.001), greater LOS (Low: 6.1 ± 3.7 days vs. Intermediate-High: 9.1 ± 7.9 days, p< 0.001), total cost of admission (Low: $78,113 ± 40,492 vs. Intermediate-High: $95,495 ± 50,598, p< 0.001), and rate of NRD (Low: 41.7% vs. Intermediate-High: 61.7%, p< 0.001). On multivariate analysis, Intermediate-High HFRS was found to be independently associated with extended LOS (OR: 2.58, p< 0.001) and NRD (OR: 1.63, p< 0.001), but not increased admission cost (OR: 1.01, p=0.929).
Conclusion : This study is the first to use the HFRS to assess the impact of frailty on perioperative outcomes in patients with ASD. Among patients with ASD, HFRS-defined frailty was associated with longer hospitalizations and more NRD, though not higher total hospital costs. The HFRS may be a viable metric in identifying frailty in the ASD population, which often portends poor outcomes.
