Key result
An elevated Hospital Frailty Risk Score (≥5) was associated with a higher 30-day readmission rate after major head and neck cancer surgery (18.0% vs 9.5%; OR 1.59, 95% CI 1.37-1.85; P<0.01).
Why the study?
The study evaluated the predictive utility of the Hospital Frailty Risk Score and other risk factors for 30-day readmissions and mortality in a nationally representative cohort.
Does an elevated frailty index (HFRS ≥5) predict unplanned 30-day readmission in patients with head and neck cancer undergoing major surgery?
Cohort (n=14,420)
Yes
Does an elevated frailty index (HFRS ≥5) predict unplanned 30-day readmission in patients with head and neck cancer undergoing major surgery?
The Hospital Frailty Risk Score (HFRS) is a significant predictor of unplanned 30-day readmission, increased length of stay, and higher costs in patients undergoing major head and neck cancer surgery.
Answers are grounded in this paper and cite their sources.
Supports preoperative frailty screening in head and neck cancer surgery; leaves open whether mitigation reduces readmissions.
Objective To evaluate the predictive utility of the Hospital Frailty Risk Score (HFRS), a stratification tool based on the ICD‐10 (International Classification of Disease, Tenth Revision), and other risk factors for 30‐day readmissions and mortality in a nationally representative cohort. Study Design Retrospective database review. Setting Nationwide Readmissions Database (2017). Methods Patients with head and neck cancer who underwent major surgical procedures were identified from the 2017 Nationwide Readmissions Database, representing 116 medical centers nationwide. Bivariate and multivariable logistic regression methods were used to identify factors associated with unplanned 30‐day readmission, 30‐day readmission mortality, and increased length of hospital stay. Results A total of 14,420 patients underwent major head and neck cancer surgery. Unplanned readmission occurred in 11% of patients. The most common reasons for unplanned readmission were procedural complications (26.5%), sepsis (7.3%), and respiratory failure (3.9%). Elevated frailty index (HFRS ≥5) was identified in 22% of patients. Frailty was associated with higher 30‐day readmission rates (18.0% vs 9.5%, P <. 01), which held on multivariate modeling (odds ratio [OR], 1.59 [95% CI, 1.37‐1.85]). Frail patients spent more days in the hospital (8.2 vs 6.8, P =. 02) and incurred more charges across hospital stays ($275,000 vs $188,000, P <. 01). Patients >75 years old (OR, 1.26 [1.03‐1.55]) and patients with electrolyte abnormalities (OR, 1.25 [1.07‐1.46] were significantly more likely to be readmitted. Conclusion In this head and neck cancer surgical population, HFRS significantly predicted unplanned readmission. HFRS is a potential risk stratification tool and should be compared with other methods and explored in other cancer populations. Beyond the challenge of identifying at‐risk patients, future work should explore potential interventions aimed at mitigating readmission.
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Voora et al. (2021) conducted a cohort in Head and neck cancer (n=14,420). Elevated frailty index (HFRS ≥5) vs. Non-frail (HFRS <5) was evaluated on 30-day readmission (OR 1.59, 95% CI 1.37-1.85, p=<0.01). An elevated Hospital Frailty Risk Score (≥5) was associated with a higher 30-day readmission rate after major head and neck cancer surgery (18.0% vs 9.5%; OR 1.59, 95% CI 1.37-1.85; P<0.01).
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