Advertisement

Response: HFRS in patients undergoing ACDF for CSM

Published:September 30, 2022DOI:https://doi.org/10.1016/j.spinee.2022.09.006
      We greatly appreciate the Letter by Rangel et al. in regard to our published work “Leveraging HFRS to Assess How Frailty Affects Healthcare Resource Utilization after Elective ACDF for CSM” [
      • Elsamadicy AA
      • Koo AB
      • Sarkozy M
      • et al.
      Leveraging HFRS to Assess How Frailty Affects Healthcare Resource Utilization after Elective ACDF for CSM [e-pub ahead of print].
      ]. We concur with the authors that there are significant limitations to analyzing an administrative billing national dataset, such as the Nationwide Inpatient Sample (NIS). Additionally, that while HFRS was validated in older patients in an acute care setting, there may still be potential use of HFRS as risk-assessment tool to identify frailty in adults with CSM. There are a variety of frailty indices that have been proposed and used throughout the medical and surgical literature, with Neurosurgery not being an exception. However, this variety exemplifies the broad spectrum in which frailty is being defined as. We believe that more population-specific frailty indices should be investigated, as patient pathologies lends itself to similar baseline characteristics. We concur that retrospectively analyzing large administrated national databases has inherent limitations that has implications in coding, statistical analyses and overall conclusions. However, through multi-institutional, prospective studies these limitations may be reduced, and coding may be more refined. We sought to assess whether there may be a potential use of HFRS in identifying at risk patients undergoing ACDF for CSM, leveraging the use of ICD-10-CM coding that is available within the NIS. We understand the limitations of both NIS and HFRS, and concur with the authors that coding discrepancies may exist such as the initial billing coding that was inserted, timeline of neurological deficits, baseline comorbidities that were newly diagnosed during the indexed admission but may have also been chronic, and post-op complications coding. We concur that more delineated coding methodologies are necessary to extract and utilize a modified HFRS coding structure - but is one of the significant limitations in large administrated billing datasets as eluded by the authors. We hope that further investigation on how HFRS or other frailty indices that depend on ICD-10-CM coding may be refined and better implemented within hospital electronic medical record systems which may shed insight in its utility.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Spine Journal
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      Reference

        • Elsamadicy AA
        • Koo AB
        • Sarkozy M
        • et al.
        Leveraging HFRS to Assess How Frailty Affects Healthcare Resource Utilization after Elective ACDF for CSM [e-pub ahead of print].
        Spine J. 2022; (accessed October 26, 2022)https://doi.org/10.1016/j.spinee.2022.08.004