BACKGROUND CONTEXT

Frailty is a common comorbidity associated with worsening outcomes in various medical and surgical fields. The Hospital Frailty Risk Score (HFRS) is a recently developed tool which assesses frailty using 109 International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) comorbidity codes to assess severity of frailty. However, there is a paucity of studies utilizing the HFRS with patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM).

PURPOSE

The aim of this study was to investigate the impact of HFRS on health care resource utilization following ACDF for CSM.

STUDY DESIGN

A retrospective cohort study was performed using the Nationwide Inpatient Sample (NIS) database from 2016-2019.

PATIENT SAMPLE

All adult (≥18 years old) patients undergoing primary, ACDF for CSM were identified using the ICD-10 CM codes.

OUTCOME MEASURES

Weighted patient demographics, comorbidities, perioperative complications, LOS, discharge disposition, and total admission costs were assessed.

METHODS

The 109 ICD-10 codes with pre-assigned values from 0.1 to 7.1 pertaining to frailty were queried in each patient, with a cumulative HFRS ≥5 indicating a frail patient. Patients were then categorized as either Low HFRS (HFRS<5) or Moderate to High HFRS (HFRS≥5). A multivariate stepwise logistic regression was used to determine the odds ratio for risk-adjusted extended LOS, non-routine discharge disposition, and increased hospital cost.

RESULTS

A total of 29,305 patients were identified, of which 3,135 (10.7%) had a Moderate to High HFRS. Patients with a Moderate to High HFRS had higher rates of 1 or more postoperative complications (Low HFRS: 9.5% vs. Moderate-High HFRS: 38.6%, p≤.001), significantly longer hospital stays (Low HFRS: 1.8±1.7 days vs. Moderate-High HFRS: 4.4 ± 6.0, p≤.001), higher rates of non-routine discharge (Low HFRS: 5.8% vs. Moderate-High HFRS: 28.2%, p≤.001), and increased total cost of admission (Low HFRS: $19,691±9,740 vs. Moderate-High HFRS: $26,935±22,824, p≤.001) than patients in the Low HFRS cohort. On multivariate analysis, Moderate to High HFRS was found to be a significant independent predictor for extended LOS [OR: 3.19, 95% CI: (2.60, 3.91), p≤.001] and non-routine discharge disposition [OR: 3.88, 95% CI: (3.05, 4.95), p≤.001] but not increased cost [OR: 1.10, 95% CI: (0.87, 1.40), p=.418].

CONCLUSIONS

Our study suggests that patients with a higher HFRS have increased total hospital costs, a longer LOS, higher complication rates, and more frequent nonroutine discharge compared with patients with a low HFRS following elective ACDF for CSM. Although frail patients should not be precluded from surgical management of cervical spine pathology, these findings highlight the need for peri-operative protocols to medically optimize patients to improve health care quality and decrease costs.

中文翻译：

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利用 HFRS 评估 CSM 选修 ACDF 后虚弱如何影响医疗保健资源利用

背景语境

虚弱是一种常见的合并症，与各种医疗和外科领域的结果恶化有关。医院虚弱风险评分 (HFRS) 是最近开发的一种评估虚弱的工具，它使用 109 国际疾病分类，第 10 版，临床修改 (ICD-10-CM) 合并症代码来评估虚弱的严重程度。然而，很少有研究利用 HFRS 对接受颈椎前路椎间盘切除融合术(ACDF) 治疗脊髓型颈椎病 (CSM) 的患者进行研究。

目的

本研究的目的是调查 HFRS 对 CSM ACDF 后医疗保健资源利用的影响。

学习规划

使用 2016-2019 年全国住院患者样本 (NIS) 数据库进行了一项回顾性队列研究。

患者样本

使用 ICD-10 CM 代码识别所有接受初级 ACDF 治疗 CSM 的成人（≥18 岁）患者。

结果测量

评估了加权患者人口统计学、合并症、围手术期并发症、LOS、出院处置和总入院费用。

方法

查询每位患者的 109 个 ICD-10 代码，这些代码具有从 0.1 到 7.1 的预分配值，与虚弱有关，累积 HFRS ≥ 5 表示虚弱患者。然后将患者分为低 HFRS (HFRS < 5) 或中度至高 HFRS (HFRS ≥ 5)。使用多变量逐步逻辑回归来确定风险调整后的延长 LOS、非常规出院处置和增加的住院费用的比值比。

结果

总共确定了 29,305 名患者，其中 3,135 名 (10.7%) 患有中度至高度 HFRS。具有中度至高度 HFRS 的患者出现 1 种或多种术后并发症的发生率更高（低 HFRS：9.5% 对比中度-高度 HFRS：38.6%，p≤.001），住院时间明显更长（低 HFRS：1.8±1.7 天）与中高 HFRS：4.4 ± 6.0，p≤.001），非常规出院率更高（低 HFRS：5.8% 与中高 HFRS：28.2%，p≤.001），总成本增加入院率（低 HFRS：$19,691±9,740 vs. 中高 HFRS：$26,935±22,824，p≤.001）低于低 HFRS 队列中的患者。在多变量分析，中度至高度 HFRS 被发现是延长 LOS [OR: 3.19, 95% CI: (2.60, 3.91), p≤.001] 和非常规出院处置 [OR: 3.88, 95] 的重要独立预测因子% CI: (3.05, 4.95), p≤.001] 但不增加成本 [OR: 1.10, 95% CI: (0.87, 1.40), p=.418]。

结论

我们的研究表明，与 CSM 的选择性 ACDF 后 HFRS 较低的患者相比，HFRS 较高的患者总住院费用增加、LOS 更长、并发症发生率更高以及非常规出院频率更高。尽管虚弱患者不应被排除在颈椎病变的手术治疗之外，但这些发现强调了围手术期方案的必要性，以从医学上优化患者以提高医疗保健质量并降低成本。