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We greatly appreciate the letter by Estes et al 1 sent in regard to our published work “Higher Hospital Frailty Risk Score (HFRS) is associated with increased complications and healthcare resource utilization after endovascular treatment of ruptured intracranial aneurysms.”2 In that study, we sought to assess the potential use of HFRS in identifying the ‘frailty risk’ of patients with ruptured aneurysms undergoing endovascular treatment, leveraging the use of ICD-10-CM coding that is available within the National Inpatient Sample. The authors have raised a few concerns, including the lack of temporality in the National Inpatient Sample to distinguish between preoperative and postoperative conditions, the limited external validity of patients outside of age and neurosurgical context, and the poor discriminatory accuracy of postoperative outcomes.
We concur with the authors’ concerns about the use of the National Inpatient Sample, as the dataset is limited …
Contributors All authors (ABK, AAE, DR, CM) contributed significantly to the design, conception, preparation, and review of the letter.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
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