Hospital frailty risk score predicts postoperative outcomes after endoscopic endonasal resection of non-functioning pituitary adenomas

Purpose Frailty indices are invaluable resources in risk stratification and predicting high-value care outcomes for neurosurgical patients. The Hospital Frailty Risk Score (HFRS) is a recently developed and validated method for evaluating frailty; however, its implementation has yet to be assessed in patients with non-functioning pituitary adenomas undergoing endoscopic endonasal resection. In this study, we aimed to evaluate HFRS's predictive ability for high-value care outcomes, namely postoperative complications, length of stay (LOS), and hospital charges, and to compare it to other traditionally used frailty indices. Methods A retrospective review of electronic medical records from 2017 to 2020. A total of 109 ICD-10 codes corresponding to various frailty-related conditions were used to identify the components of HFRS. These components were then used to calculate the HFRS for each patient, with higher scores indicative of elevated frailty. Standard multivariate logistic regression models were employed to explore the association between HFRS and high-value care outcomes. Model discrimination was assessed using the area under the ROC curves, and the DeLong test was used to compare AUCs. Results A total of 172 patients were included, with a mean age of 57.27 +/- 12.95 years and an average HFRS score of 3.65 +/-+/- 3.27. Among patients, 56% were male, 5.2% experience postoperative complications, 23.3% endured extended LOS, 25.0% incurred high hospital charges. In multivariate regression models, greater HFRS was significantly and independently associated with postoperative complications (OR = 1.51, P < 0.001), extended LOS (OR = 1.17, P = 0.006) and high hospital charges (OR = 1.18, P = 0.004). HFRS had the highest AUC compared to other frailty indices and was the most parsimonious model, with AUC values of 0.82, 0.64, and 0.63 for predicting complications, extended LOS, and higher charges, respectively. Conclusion Higher HFRS scores are significantly associated with postoperative complications, prolonged LOS, and high hospital charges for patients undergoing pituitary surgery.