School of Medicine, Georgetown University, Washington , District of Columbia , USA.
Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque , New Mexico , USA.
Neurosurgery. 2024 Feb 1;94(2):251-262. doi: 10.1227/neu.0000000000002668. Epub 2023 Sep 11.
The Hospital Frailty Risk Score (HFRS) is an International Classification of Disease 10th Revision-based scale that was originally designed for, and validated in, the assessment of patients 75 years or older presenting in an acute care setting. This study highlights central tenets inherent to the concept of frailty; questions the logic behind, and utility of, HFRS' recent implementation in the neurosurgical literature; and discusses why there is no useful role for HFRS as a frailty-based neurosurgical risk assessment (FBNRA) tool.
The authors performed a systematic review of the literature per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including all cranial and spinal studies that used HFRS as their primary frailty tool. Seventeen (N = 17) studies used HFRS to assess frailty's impact on neurosurgical outcomes. Thirteen total journals, 10 of which were neurosurgical journals, including the highest impact factor journals, published the 17 papers.
Increasing HFRS score was associated with adverse outcomes, including prolonged length of stay (11 of 17 studies), nonroutine discharge (10 of 17 studies), and increased hospital costs (9 of 17 studies). Four different HFRS studies, of the 17, predicted one of the following 4 adverse outcomes: worse quality of life, worse functional outcomes, reoperation, or in-hospital mortality.
Despite its rapid acceptance and widespread proliferation through the leading neurosurgical journals, HFRS lacks any conceptual relationship to the frailty syndrome or FBNRA for individual patients. HFRS measures acute conditions using International Classification of Disease 10th Revision codes and awards "frailty" points for symptoms and examination findings unrelated to the impaired baseline physiological reserve inherent to the very definition of frailty. HFRS lacks clinical utility as it cannot be deployed point-of-care at the bedside to risk stratify patients. HFRS has never been validated in any patient population younger than 75 years or in any nonacute care setting. We recommend HFRS be discontinued as an individual FBNRA tool.
医院衰弱风险评分（HFRS）是一种基于国际疾病分类第 10 版的量表，最初是为 75 岁及以上的急性护理环境中的患者设计和验证的。本研究强调了衰弱概念固有的核心原则；质疑了 HFRS 在神经外科学文献中的近期应用背后的逻辑和实用性；并讨论了为什么 HFRS 作为基于衰弱的神经外科风险评估（FBNRA）工具没有任何有用的作用。
作者按照系统评价和荟萃分析的首选报告项目进行了文献系统评价，包括所有使用 HFRS 作为主要衰弱工具的颅和脊柱研究。有 17 项研究（N=17）使用 HFRS 评估衰弱对神经外科结局的影响。共有 13 种期刊，其中 10 种是神经外科期刊，包括影响因子最高的期刊，发表了这 17 篇论文。
HFRS 评分增加与不良结局相关，包括住院时间延长（17 项研究中的 11 项）、非常规出院（17 项研究中的 10 项）和住院费用增加（17 项研究中的 9 项）。在这 17 项研究中，有 4 项不同的 HFRS 研究预测了以下 4 种不良结局之一：生活质量更差、功能结局更差、再次手术或住院内死亡。
尽管 HFRS 迅速被接受并在领先的神经外科期刊中广泛传播，但它与衰弱综合征或个体患者的 FBNRA 没有任何概念上的关系。HFRS 使用国际疾病分类第 10 版代码来衡量急性疾病，并根据与衰弱定义所固有的受损基础生理储备无关的症状和检查结果授予“衰弱”积分。HFRS 缺乏临床实用性，因为它不能在床边进行即时护理，以对患者进行风险分层。HFRS 从未在任何年龄小于 75 岁或任何非急性护理环境的患者人群中得到验证。我们建议停止将 HFRS 作为个体 FBNRA 工具使用。
