Hello, everyone. I hope that you and your loved ones are safe and healthy during this unprecedented time. My name is Annie Arigi-Allison, and I'm a third-year medical student at the Icahn School of Medicine at Mount Sinai. Today, I'll be speaking about the utility of the hospital frailty risk score in predicting outcomes of intracranial tumor patients. Thank you to my co-authors, to Mount Sinai, and to the AANS for the opportunity to virtually present this work. The hospital frailty risk score, or HFRS, is a systematic screening tool developed by Gilbert et al. in 2018 that is aimed at identifying patients at greater risk for mortality and morbidity using administrative billing records. Its utility in predicting outcomes of patients with intracranial tumors, however, is yet unelucidated. The national inpatient sample was queried for all records of intracranial tumors of benign, malignant, metastatic, or secondary, or uncertain nature. Frailty was determined by the HFRS, which was calculated using ICD-10 codes for markers of frailty, such as Alzheimer's, Parkinson's, or delirium. Patients were sorted into low, medium, and high frailty groups. Demographics and outcomes were then compared between frailty groups and tumor types. This first table compares the distributions of Elixhauser Comorbidity Indices, or ECIs, tumor types, and average ages of patients across low, medium, and high frailty groups. Importantly, these indices were significantly different across groups, supporting the idea that the HFRS is capable of categorizing these patients into discrete groups. For example, patients in the high HFRS cohort were significantly older and possessed a greater number of preoperative comorbidities than did those in the medium or low HFRS groups. This table explores the association between HFRS category, i.e., purported frailty level, and several outcomes, death, length of stay, and non-home discharge. I'd like to draw your attention to the top of the table, which shows a positive association between HFRS and mortality rate, regardless of tumor type. Even in the benign category of tumors, the mortality rate of high HFRS patients with tumors is 2-3 times that of the medium frailty group, and nearly 22 times that of the low frailty cohort. A similar effect was observed when examining non-home discharge and length of stay. For example, patients with malignant tumors and high HFRS experienced, on average, a length of stay seven days longer than patients with medium HFRS, and the likelihood of non-home discharge across all tumor types increased significantly as HFRS grew. Our data show that higher frailty score is associated with increased mortality, non-home discharge, and length of stay in patients with intracranial tumors of various behaviors. This scale represents a low-cost, automatable prognostic tool to identify intracranial tumor patients at higher risk of poor outcomes and increased resource utilization. It is important to recognize some limitations of this study. Firstly, one NIS entry is equivalent to one hospitalization. One patient may, therefore, contribute more than one entry if they were hospitalized more than once, which would be highly likely for someone with metastatic cancer with intracranial spread. It is also possible that the same patient may have been recorded under different outcomes. For example, they were transferred from one facility, which constitutes one entry, to another, where they eventually passed away, which would constitute a second entry with a different outcome. Additionally, this study was retrospective, which may lead to other partially confounding biases. Further studies should explore whether this trend applies to specific surgical approaches as well. For example, whether increased frailty is associated with higher resource burden following transcranial or transphenoidal approaches to intracranial neoplasms. Thank you.

Annie Arigi-Allison

medical student

hospital frailty risk score

intracranial tumors

mortality rate