A Commentary on ‘Predicting outcomes in older patients undergoing vascular surgery using the Hospital Frailty Risk Score’

Dear Editor We read the latest article by Aitken et al. with great interest1. The authors recognise the importance of frailty in relation to adverse surgical outcomes and propose the use of the Hospital Frailty Risk Score (HFRS) as a predictive prognostic tool for vascular surgery. While the authors acknowledge limitations associated with using administrative health data, we would like to further comment on the use of clinical codes for designing surgical outcome prediction tools. Coded data, while yielding itself to retrospective analysis, pose challenges when applied to clinical settings. ICD-10-AM codes related to current hospital admission are not routinely available before discharge. As such, the HFRS tool only captures baseline frailty, failing to account for the fluctuating nature of physiological processes, thus reducing its predictive power. Moreover, the overlap between clinical codes for comorbidities and complications prevented the authors from analysing morbidity outcomes, further highlighting the risk of depriving the data of much-needed granularity stemming from the use of electronic healthcare records. Aitken et al. did not differentiate between elective and emergency procedures in this study, increasing the heterogeneity of the patient population. This is of particular importance, as non-elective patients may suffer from a greater deterioration in their physiological reserve, and consequently higher frailty during their current admission. Furthermore, it reinforces the aforementioned limitations allied to only using previous hospital admission data when assessing frailty due to its dynamic nature. We commend the authors for their work in this area of growing importance. However, given the nature of administrative healthcare records and ICD-10-AM codes, the rationale that HFRS will provide additional clinical value in frailty assessment for vascular patients by predicting adverse outcomes is questionable. Instead, there is potential merit for HFRS utilisation at a service-planning level by estimating frailty prevalence. All authors have contributed equally. Disclosure: The authors have no conflict of interest to declare.