Response To Correspondence Re 'Predicting Outcomes In Older Patients Undergoing Vascular Surgery Using The Hospital Frailty Risk Score' By Guijuri Et Al.

Background Frailty may explain why some older patients having vascular surgery are at high risk of adverse outcomes. The Hospital Frailty Risk Score (HFRS) has been designed specifically for use with administrative data and has three categories of frailty risk (low, intermediate and high). The aim of this study was to evaluate the HFRS in predicting mortality, and hospital use in older patients undergoing vascular surgery. Methods Routinely collected hospital data linked to death records were analysed for all patients aged 75 years or older who had undergone either endovascular or open vascular surgery between 2010 and 2012 in New South Wales, Australia. Multilevel logistic regression models were used to compare outcomes adjusted for patient and procedural factors, with and without frailty. Results Some 9752 patients were identified, of whom 1719 (17 center dot 6 per cent) had a high-risk HFRS. Patients in the high-risk frailty category had an adjusted odds ratio for death by 30 days after surgery of 4 center dot 15 (95 per cent c.i. 2 center dot 99 to 5 center dot 76) compared with those in the low-risk frailty category, and a similarly increased odds of death by 2 years (odds ratio 4 center dot 27, 3 center dot 69 to 4 center dot 95). Adding the HFRS to a model adjusted for age, sex, co-morbidity score, socioeconomic status, previous hospitalization and vascular procedure type improved the prediction of 2-year mortality and prolonged hospital stay, but there was minimal improvement for 30-day mortality and readmission. Conclusion Adjusting for the HFRS in addition to other patient and procedural risk factors provided greater discrimination of outcomes in this cohort of older patients undergoing vascular surgery.