Association of Frailty Risk with Hospital Outcomes after Surgical Resection for Benign and Malignant Spinal Meningiomas
Authors: Elsamadicy Aladine , Koo Andrew , Reeves Benjamin , Craft Samuel , Sherman Josiah , Sarkozy Margot , Aurich Lucas , Kolb Luis , Shin John , Sciubba Daniel , Mendel Ehud 
Published: October 2022

Abstract
OBJECTIVE
The Hospital Frailty Risk Score (HFRS) is a metric used to assess patient frailty risk in large national datasets using International Classification of Diseases, Tenth Revision (ICD-10) codes. While previous studies have assessed the association between frailty risk and postoperative outcomes in spine oncology, there is a paucity of data on the relationship between frailty risk and outcomes in patients undergoing surgery for spinal meningiomas. The goal of this study was to investigate the association between HFRS and hospital length of stay (LOS), discharge disposition, and cost of admission in patients undergoing surgery for spinal meningiomas.
METHODS
A retrospective cohort study was performed using the National Inpatient Sample Database from 2016 to 2019. Adult patients with benign or malignant spine meningiomas, identified using ICD-10 diagnostic and procedural coding, were stratified by HFRS: Low (HFRS < 5) and Intermediate-High (HFRS ≥ 5). These cohorts were further stratified by patient sex. Patient demographics, treating hospital characteristics, comorbidities, intraoperative variables, perioperative adverse events (AEs), LOS, discharge disposition, and cost of admission were assessed. Logistic multivariate regression analyses were performed to identify the associations between increased HFRS and LOS, discharge disposition, and cost in male and female patients.
RESULTS
Of the 3,345 study patients, 530 (15.8%) had Intermediate-High Frailty. Of the 530 Intermediate-High risk patients, 410 (77.4%) were female and of the 2,815 Low risk patients, 2,185 (77.6%) were female. The Intermediate-High cohort was significantly older (Low: 60.94±14.63 years vs Intermediate-High: 66.93±14.23 years, p < 0.001). A greater proportion of patients in the Intermediate-High cohort had three or more comorbidities (Low: 32.5% vs Intermediate-High: 74.5%, p < 0.001). Additionally, a greater proportion of patients in the Intermediate-High cohort experienced one or more perioperative AEs (Low: 7.1% vs Intermediate-High: 14.2, p = 0.018). Intermediate-High patients had longer mean LOS (Low: 4.02±2.30 days vs Intermediate-High: 7.14±6.03 days, p < 0.001) and higher mean total costs (Low: $24,344±$16,743 vs Intermediate-High: $37,013±$27,547, p < 0.001). Furthermore, a greater proportion of Intermediate-High patients had non-routine discharges (Low: 27.9% vs Intermediate-High: 55.7%, p < 0.001). On multivariate analysis, increased HFRS scores (≥ 5) were significantly associated with extended LOS (p < 0.001), non-routine discharge (p = 0.006), and increased costs (p = 0.004).
CONCLUSION
Our study shows that increased HFRS-defined frailty risk is significantly associated with extended LOS, non-routine discharge disposition, and increased costs in patients undergoing surgery for spine meningiomas. Further studies on the implications of frailty in these patients are merited in order to improve patient outcomes and healthcare resource utilization.