Kazemi Foad, Liu Jiaqi, Parker Megan, Jimenez Adrian E, Ahmed A Karim, Salvatori Roberto, Hamrahian Amir H, Rowan Nicholas R, Ramanathan Murugappan, London Nyall R, Ishii Masaru, Rincon-Torroella Jordina, Gallia Gary L, Mukherjee Debraj
Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA.
Georgetown University School of Medicine, Washington, DC, USA.
Pituitary. 2025 Feb 3;28(1):27. doi: 10.1007/s11102-024-01496-8.
Frailty indices are invaluable resources in risk stratification and predicting high-value care outcomes for neurosurgical patients. The Hospital Frailty Risk Score (HFRS) is a recently developed and validated method for evaluating frailty; however, its implementation has yet to be assessed in patients with non-functioning pituitary adenomas undergoing endoscopic endonasal resection. In this study, we aimed to evaluate HFRS's predictive ability for high-value care outcomes, namely postoperative complications, length of stay (LOS), and hospital charges, and to compare it to other traditionally used frailty indices.
A retrospective review of electronic medical records from 2017 to 2020. A total of 109 ICD-10 codes corresponding to various frailty-related conditions were used to identify the components of HFRS. These components were then used to calculate the HFRS for each patient, with higher scores indicative of elevated frailty. Standard multivariate logistic regression models were employed to explore the association between HFRS and high-value care outcomes. Model discrimination was assessed using the area under the ROC curves, and the DeLong test was used to compare AUCs.
A total of 172 patients were included, with a mean age of 57.27 ± 12.95 years and an average HFRS score of 3.65 3.27. Among patients, 56% were male, 5.2% experience postoperative complications, 23.3% endured extended LOS, 25.0% incurred high hospital charges. In multivariate regression models, greater HFRS was significantly and independently associated with postoperative complications (OR = 1.51, P < 0.001), extended LOS (OR = 1.17, P = 0.006) and high hospital charges (OR = 1.18, P = 0.004). HFRS had the highest AUC compared to other frailty indices and was the most parsimonious model, with AUC values of 0.82, 0.64, and 0.63 for predicting complications, extended LOS, and higher charges, respectively.
Higher HFRS scores are significantly associated with postoperative complications, prolonged LOS, and high hospital charges for patients undergoing pituitary surgery.
衰弱指数是神经外科患者风险分层和预测高价值护理结局的宝贵资源。医院衰弱风险评分（HFRS）是一种最近开发并经过验证的评估衰弱的方法；然而，其在接受鼻内镜下切除术的无功能垂体腺瘤患者中的应用尚未得到评估。在本研究中，我们旨在评估HFRS对高价值护理结局（即术后并发症、住院时间（LOS）和医院费用）的预测能力，并将其与其他传统使用的衰弱指数进行比较。
对2017年至2020年的电子病历进行回顾性研究。总共使用了109个与各种衰弱相关疾病对应的ICD-10编码来确定HFRS的组成部分。然后使用这些组成部分为每位患者计算HFRS，分数越高表明衰弱程度越高。采用标准多变量逻辑回归模型探讨HFRS与高价值护理结局之间的关联。使用ROC曲线下面积评估模型辨别力，并使用DeLong检验比较AUC。
共纳入172例患者，平均年龄57.27±12.95岁，平均HFRS评分为3.65±3.27。患者中，56%为男性，5.2%发生术后并发症，23.3%住院时间延长，25.0%医院费用较高。在多变量回归模型中，较高的HFRS与术后并发症（OR = 1.51，P < 0.001）、住院时间延长（OR = 1.17，P = 0.006）和医院费用较高（OR = 1.18，P = 0.004）显著且独立相关。与其他衰弱指数相比，HFRS的AUC最高，且是最简约的模型，预测并发症、住院时间延长和费用较高的AUC值分别为0.82、0.64和0.63。
较高的HFRS评分与垂体手术患者的术后并发症、住院时间延长和医院费用较高显著相关。
