Elsamadicy Aladine A, Koo Andrew B, Sherman Josiah J Z, Sarkozy Margot, Reeves Benjamin C, Craft Samuel, Sayeed Sumaiya, Sandhu Mani Ratnesh S, Hersh Andrew M, Lo Sheng-Fu Larry, Shin John H, Mendel Ehud, Sciubba Daniel M
Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Eur Spine J. 2023 Mar 22. doi: 10.1007/s00586-023-07635-2.
The Hospital Frailty Risk Score (HFRS) is a frailty-identifying metric developed using ICD-10-CM codes. While other studies have examined frailty in adult spinal deformity (ASD), the HFRS has not been assessed in this population. The aim of this study was to utilize the HFRS to investigate the impact of frailty on outcomes in ASD patients undergoing posterior spinal fusion (PSF).
A retrospective 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, and outcomes were assessed. Multivariate regression analyses were used to determine whether HFRS independently predicted extended length of stay (LOS), non-routine discharge, and increased cost.
Of the 7500 patients identified, 4000 (53.3%) were in the Low HFRS cohort and 3500 (46.7%) were in the Intermediate-High HFRS cohort. On average, age increased progressively with increasing HFRS scores (p < 0.001). The frail cohort experienced more postoperative adverse events (p < 0.001), greater LOS (p < 0.001), accrued greater admission costs (p < 0.001), and had a higher rate of non-routine discharge (p < 0.001). On multivariate analysis, Intermediate-High HFRS was independently associated with extended LOS (OR: 2.58, p < 0.001) and non-routine discharge (OR: 1.63, p < 0.001), though not increased admission cost (OR: 1.01, p = 0.929).
Our study identified HFRS to be significantly associated with prolonged hospitalizations and non-routine discharge. Other factors that were found to be associated with increased healthcare resource utilization include age, Hispanic race, West hospital region, large hospital size, and increasing number of AEs.
医院衰弱风险评分（HFRS）是一种利用国际疾病分类第十版临床修正版（ICD - 10 - CM）编码开发的衰弱识别指标。虽然其他研究已经探讨了成人脊柱畸形（ASD）中的衰弱情况，但HFRS尚未在该人群中进行评估。本研究的目的是利用HFRS来调查衰弱对接受后路脊柱融合术（PSF）的ASD患者预后的影响。
使用2016 - 2019年国家住院样本数据库进行回顾性研究。使用ICD - 10 - CM编码识别接受择期PSF的成年ASD患者。患者被分为基于HFRS的衰弱队列：低（HFRS＜5）和中高（HFRS≥5）。评估患者的人口统计学特征、合并症、术中变量和预后。采用多因素回归分析来确定HFRS是否能独立预测延长住院时间（LOS）、非常规出院和费用增加。
在识别出的7500例患者中，4000例（53.3%）属于低HFRS队列，3500例（46.7%）属于中高HFRS队列。平均而言，年龄随着HFRS评分的增加而逐渐升高（p＜0.001）。衰弱队列经历了更多的术后不良事件（p＜0.001）、更长的住院时间（p＜0.001）、更高的入院费用（p＜0.001）以及更高的非常规出院率（p＜0.001）。多因素分析显示，中高HFRS与延长住院时间（OR：2.58，p＜0.001）和非常规出院（OR：1.63，p＜0.001）独立相关，但与入院费用增加无关（OR：1.01，p = 0.929）。
我们的研究发现HFRS与延长住院时间和非常规出院显著相关。其他被发现与医疗资源利用增加相关的因素包括年龄、西班牙裔种族、西部医院地区、大型医院规模以及不良事件数量增加。
