Resident Physician Yale School of Medicine New Haven, Connecticut, United States
Introduction: Frailty has been shown to portend poor outcomes following spinal procedures, though the HFRS has not been assessed in the population. The Hospital Frailty Risk Score (HFRS) is a metric of frailty developed using ICD-10 CM codes. The aim of this study was to determine the impact of HFRS-defined frailty on outcomes in patients who undergo surgical management for odontoid fractures.
Methods: A retrospective cohort study was performed using the 2016-2019 National Inpatient Sample database. Adult patients who underwent surgery for odontoid fractures, identified using ICD-10-CM coding, were categorized by HFRS-defined frailty: Low (HFRS < 5) and Intermediate-High (HFRS≥5). Demographics, comorbidities, intraoperative variables, and outcomes were assessed. Multivariate analyses were used to identify independent associations between frailty and length of stay (LOS), non-routine discharge, and costs.
Results: Of the 9,895 patients identified, 4,060 (41.0%) were in the Low HFRS cohort and 5,835 (59.0%) were in the Intermediate-High (IH) HFRS cohort. Patients in the IH cohort were older (p < 0.001), had more comorbidities (≥3 comorbidities: Low:31.9% vs. IH:68.4%,p < 0.001), and were more likely to be insured by Medicare (p < 0.001). Frailer patients experienced higher rates of post-operative complications (≥1 AE: Low:10.9% vs. IH:34.7%,p < 0.001). Frailer patients had significantly higher LOS (Low:5.04±4.12 days vs. IH:10.50±8.52 days,p < 0.001), accrued higher mean costs (Low:$27,141.92±17,879.85 vs. IH:$46,528.93±39,804.69,p < 0.001), and were more likely to undergo non-routine discharge (Low:28.5% vs. IH:63.4%,p < 0.001). On multivariate analysis, compared to Low HFRS, Intermediate-High HFRS was found to be independently associated with extended LOS [OR:5.97,CI (4.30, 8.28),p < 0.001), non-routine discharge [OR:3.29,CI (2.64, 4.10),p < 0.001], and increased costs [OR:1.45,CI (1.04, 2.23)p=0.030].
Conclusion : This study shows that increased HFRS-defined frailty is significantly associated with extended LOS, non-routine discharge, and increased costs following surgery for odontoid fractures. Further studies are necessary to better risk-stratify patients presenting with increasing HFRS scores to better patient care and reduce healthcare costs.
