Abstract
We greatly appreciate the Letter in regard to our published work “Hospital Frailty Risk Score and Healthcare Resource Utilization After Surgery for Primary Spinal Intradural/Cord Tumors”. We concur 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, the potential utility of HFRS shouldn’t be diminished. There are a variety of frailty indices that have been used throughout the medical and surgical literature, including within Neurosurgery, exemplifying the spectrum in which frailty is being defined as. We believe that more population-specific frailty indices should be investigated, through multi-institutional, prospective studies. We sought to assess whether there may be a potential use of HFRS within various spine patient-pathologies, 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 there may be coding discrepancies may exist such as the initial billing coding, spatial timeline of neurological deficits, baseline comorbidities that were newly diagnosed but may have been chronic, post-op complications coding, and within cost and discharge disposition metrics. 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. With the early experience of HFRS and coding refinement, we believe there may be utility.
Once again, we greatly appreciate the comments and we hope that further work in this area may allow us to better risk stratify and care for our patients.
