Association between Hospital Frailty Risk Score and length of hospital stay, hospital mortality, and hospital costs for all adults in England: a nationally representative, retrospective, observational cohort study
Abstract
BACKGROUND
Studies have shown that the Hospital Frailty Risk Score (HFRS) is significantly associated with length of stay, in-hospital mortality, and costs in people aged 75 years and older. However, its applicability to hospitalised adults of all ages is unclear. We aimed to examine the association between the HFRS and these three outcomes in a nationally representative sample of adults aged 18 years and older, admitted for emergency hospital care.
METHODS
The analytical sample comprised 1 478 554 emergency hospital admissions for 653 294 patients-a 5% random sample of all emergency admissions for those aged 18 years and older to any English National Health Service acute hospital between April 1, 2011, and March 31, 2019. Admissions were categorised into zero (HFRS=0), low (015) frailty risk categories. We analysed the association between these categories and three outcomes: length of stay (Poisson model), in-hospital death (probit model); and hospital costs (generalised linear model). Models controlled for patient characteristics and temporal effects and were run separately across nine age groups (18-24 years, 25-34 years, 35-44 years, 45-54 years, 55-64 years, 65-74 years, 75-84 years, 85-94 years, and ≥95 years).
FINDINGS
The prevalence of high frailty risk increased with age, from 210 (0·2%) of 96 296 admissions for those aged 18-24 years to 9414 (42·0%) of 22 431 admissions for those aged 95 years and older. There were significant associations between frailty risk and…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 653 participants or records.
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