A large national study found that the Hospital Frailty Risk Score outperformed three other frailty scoring systems in predicting in-hospital mortality and complications among patients undergoing emergency general surgery.
Investigators analyzed data from more than 1.38 million adult patients who underwent emergency operations between 2016 and 2021, including appendectomy, cholecystectomy, bowel resections, repair of perforated ulcers, lysis of adhesions, and laparotomy. Procedures were included if performed within 3 days of admission.
Frailty was assessed using four tools: the Hospital Frailty Risk Score (HFRS), the Modified 5-Factor Frailty Index (mFI-5), the Modified 11-Factor Frailty Index (mFI-11), and the Johns Hopkins Adjusted Clinical Groups (ACG) index.
The instruments varied in the proportion of patients classified as frail. The mFI-11 identified 57.0% as frail, followed by the HFRS (29.9%), mFI-5 (26.6%), and ACG (10.5%). However, the HFRS most accurately predicted which patients were at higher risk of mortality and complications.
Among the patients deemed frail by the HFRS, the in-hospital mortality rate was 7.2%, compared with 0.2% among non-frail patients. After adjusting for risk factors, frail patients identified by the HFRS had nearly eight times higher risk of in-hospital mortality. They also had increased risks of experiencing complications, including respiratory failure, infections, renal injury, and cardiovascular events.
The HFRS demonstrated the highest accuracy in predicting outcomes, with an area under the curve (AUC) of 0.93 for mortality and 0.85 for overall complications. Other tools showed lower AUCs for complications, ranging from 0.79 to 0.80.
The greater performance of the HFRS may stem from its use of weighted diagnostic codes that account for both chronic and acute conditions. Other tools either assign equal weight to each diagnosis or incorporate social determinants, which may limit predictive accuracy in surgical settings.
Across all tools, frail patients were generally older and had higher rates of comorbidities such as cancer, anemia, and heart disease. They also had longer hospital stays and were more often discharged to nonhome settings.
The findings supported the use of frailty assessment to inform clinical decision-making, optimize resource allocation, and manage patient expectations. Among the tools evaluated, the investigators argued that the HFRS may provide a more scalable and precise approach for risk stratification in emergency surgical settings, particularly among older adults.
The study used de-identified data from a nationwide hospital database and was exempt from institutional review board review. One author reported unrelated industry compensation; the rest disclosed no conflicts of interest.
Full disclosures can be found in the published study.
Source: Surgery
