Assistant Professor Johns Hopkins University School of Medicine Baltimore, MD, US
Introduction: Brain metastases (BM) are the most common adult intracranial tumors, representing a significant source of morbidity in patients with systemic malignancy. Frailty indices have recently demonstrated an important role in predicting high-value care postoperative outcomes in neurosurgery. This study aims to investigate the efficacy of the newly developed Hospital Frailty Risk Score (HFRS) on postoperative outcomes in BM patients.
Methods: Adult (>=18 years) patients with BM treated surgically at a single institution (January 2017-December 2019) were identified. HFRS was calculated using 109 ICD-10 codes with pre-assigned values from 0.1 to 7.1 pertaining to frailty, with a higher cumulative HFRS score indicating more frail patients. Also, ASA, CCI, mFI-11, and mFI-5 scores were determined for each patient.
Model discrimination was assessed using the area under the receiver operating characteristic curve (AUROC). DeLong test was used to test for significant differences between AUROCs. Multivariate logistic regression models were utilized to identify associations between HFRS and length of stay (LOS), hospital charges, discharge disposition, and complications.
Results: A total of 356 patients were included (mean age: 61.82±11.63; 50.6% female) with mean HFRS score of 6.46±5.73. HFRS had significantly greater AUROC than mFI-5, CCI, ASA, or mFI-11 for extended LOS (0.70 vs 0.58 vs 0.56 vs 0.58 vs 0.59, P= 0.009, 0.004, 0.005, and 0.012, respectively) and higher hospital charges (0.66 vs 0.56 vs 0.54 vs 0.57 vs 0.56, P= 0.014, 0.004, 0.019, and 0.009, respectively). HFRS also had greater AUROC than mFI-5, CCI, ASA, or mFI-11 for complications and non-routine discharge disposition. In multivariate analysis, higher HFRS was significantly and independently associated with extended LOS (OR=1.13), higher hospital charges (OR=1.14), non-routine discharge disposition (OR=1.12), and greater complications (OR=1.10).
Conclusion : HFRS is an excellent predictor compared to other frailty indices, and its application offers a new avenue to better patient care among BM patients.
