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  • Higher Hospital Frailty Risk Score is associated with increased complications and healthcare resource utilization after endovascular treatment of ruptured intracranial aneurysms

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Hemorrhagic stroke
Original research
Higher Hospital Frailty Risk Score is associated with increased complications and healthcare resource utilization after endovascular treatment of ruptured intracranial aneurysms
  1. Andrew B Koo1,
  2. Aladine A Elsamadicy1,
  3. Daniela Renedo1,
  4. Margot Sarkozy1,
  5. Josiah Sherman1,
  6. Benjamin C Reeves1,
  7. John Havlik1,
  8. Joseph Antonios1,
  9. Nanthiya Sujijantarat1,
  10. Ryan Hebert1,
  11. Ajay Malhotra2,
  12. Charles Matouk1
  1. 1 Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2 Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Charles Matouk, Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA; charles.matouk{at}yale.edu

Abstract

Aim To use the Hospital Frailty Risk Score (HFRS) to investigate the impact of frailty on complication rates and healthcare resource utilization in patients who underwent endovascular treatment of ruptured intracranial aneurysms (IAs).

Methods A retrospective cohort study was performed using the 2016–2019 National Inpatient Sample database. All adult patients (≥18 years) undergoing endovascular treatment for IAs after subarachnoid hemorrhage were identified using ICD-10-CM codes. Patients were categorized into frailty cohorts: low (HFRS <5), intermediate (HFRS 5–15) and high (HFRS >15). Patient demographics, adverse events, length of stay (LOS), discharge disposition, and total cost of admission were assessed. Multivariate logistic regression analysis was used to identify independent predictors of prolonged LOS, increased cost, and non-routine discharge.

Results Of the 33 840 patients identified, 7940 (23.5%) were found to be low, 20 075 (59.3%) intermediate and 5825 (17.2%) high frailty by HFRS criteria. The rate of encountering any adverse event was significantly greater in the higher frailty cohorts (low: 59.9%; intermediate: 92.4%; high: 99.2%, p<0.001). There was a stepwise increase in mean LOS (low: 11.7±8.2 days; intermediate: 18.7±14.1 days; high: 26.6±20.1 days, p<0.001), mean total hospital cost (low: $62 888±37 757; intermediate: $99 670±63 446; high: $134 937±80 331, p<0.001), and non-routine discharge (low: 17.3%; intermediate: 44.4%; high: 69.4%, p<0.001) with increasing frailty. On multivariate regression analysis, a similar stepwise impact was found in prolonged LOS (intermediate: OR 2.38, p<0.001; high: OR 4.49, p<0.001)], total hospital cost (intermediate: OR 2.15, p<0.001; high: OR 3.62, p<0.001), and non-routine discharge (intermediate: OR 2.13, p<0.001; high: OR 4.17, p<0.001).

Conclusions Our study found that greater frailty as defined by the HFRS was associated with increased complications, LOS, total costs, and non-routine discharge.

  • aneurysm
  • complication
  • economics

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. Not applicable.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/neurintsurg-2021-018484

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplemental information. Not applicable.

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    Footnotes

    • Twitter @AjayMalhotraRad

    • Contributors ABK: Study conception and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis. AAE: Study conception and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content. DR, MS, JS, BCR, JH, JA, NS: Acquisition of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content. RH: Study conception and design, critical revision of the manuscript for important intellectual content, study supervision. AM: Study conception and design, critical revision of the manuscript for important intellectual content, study supervision. CM: Study conception and design, critical revision of the manuscript for important intellectual content, study supervision, guarantor of the study.

    • 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; externally 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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