The Hospital Frailty Risk Score and outcomes in head and neck cancer surgery.

OBJECTIVE: This study aimed to assess if the Hospital Frailty Risk Score (HFRS) could predict outcomes for older people undergoing head and neck procedures. DESIGN: A retrospective cohort study of patients admitted between April 2008 and February 2020, undergoing head and neck procedures defined as major resections using procedural codes. SETTING: The analysis was performed using data from the NHS Secondary Uses Service (SUS) electronic database. PARTICIPANTS: A number of 7479 patients were selected based on an age of 75 years and above and an admission associated with a diagnostic code associated with a head and neck cancer. Based on HFRS, 5153 patients were risk-stratified into mild, moderate, and severe frailty risk. MAIN OUTCOME MEASURES: The relationships between frailty risk and length of stay, readmission rate, and mortality were quantified using descriptive statistics. RESULTS: Severely frail patients had a median length of stay of 9 days compared to 3 for mildly frail patients. Twenty-seven percentage of severely frail patients were readmitted within 30 days of surgery. Rising levels of frailty correlate with a higher risk of death following surgery which is maintained in longer term mortality at 1 year and until the data were extracted in March 2022. Fifty percentage of moderately frail patients and 66% of severely frail patients had died in hospital by the end of the study period. CONCLUSION: The results quantify the relationship between frailty and adverse health outcomes. This information could be used to identify those that might benefit from holistic assessment, aid prognostication, commissioning, and service planning.

Developing frailty friendly hospitals: the Specialised Clinical Frailty Network.

Introduction: The aim of the Specialised Clinical Frailty Network (SCFN) was to develop frailty-attuned pathways in specialised services in England. Methods: We developed a breakthrough series collaborative involving a range of specialised services, using quality improvement methods (including experience-based design) to implement improvements designed to enhance the experience and outcomes of older people living with frailty who have specialised healthcare needs. Results: Specialised teams responded positively to the SCFN, many implementing process changes aligned to the needs of older people living with frailty. Some were able to demonstrate improvements in service and/or patient outcomes, including greater identification of frailty, more holistic care and increased use of shared decision making. Discussion: The network has successfully demonstrated how frailty can be assessed both at individual, as well as population level, to support both local teams and systems to best manage the health of their patients.

The association between frailty risk and COVID-19-associated all-mortality in hospitalised older people: a national cohort study.

INTRODUCTION: Frailty has emerged as an important construct to support clinical decision-making during the COVID-19 pandemic. However, doubts remain related to methodological limitations of published studies. METHODS: Retrospective cohort study of all people aged 75 + admitted to hospital in England between 1 March 2020 and 31 July 2021. COVID-19 and frailty risk were captured using International Classification of Disease-10 (ICD-10) diagnostic codes. We used the generalised gamma model to estimate accelerated failure time, reporting unadjusted and adjusted results. RESULTS: The cohort comprised 103,561 individuals, mean age 84.1, around half female, 82% were White British with a median of two comorbidities. Frailty risk was distributed approximately 20% low risk and 40% each at intermediate or high risk. In the unadjusted survival plots, 28-day mortality was almost 50% for those with an ICD-10 code of U071 (COVID-19 virus identified), and 25-35% for those with U072 (COVID-19 virus not identified). In the adjusted analysis, the accelerated failure time estimates for those with intermediate and high frailty risk were 0.63 (95% CI 0.58-0.68) and 0.67 (95% CI 0.62-0.72) fewer days alive respectively compared to those with low frailty risk with an ICD-10 diagnosis of U072 (reference category). CONCLUSION: In older people with confirmed COVID-19, both intermediate and high frailty risk were associated with reduced survival compared to those with low frailty risk.

The Hospital Frailty Risk Score-outcomes in specialised services.

BACKGROUND: Frailty is increasingly used to risk stratify older people, but across specialised services there is no standardised approach. The aim of this study was to assess if the Hospital Frailty Risk Score (HFRS) could describe outcomes for older people within English specialised services. DESIGN: A retrospective cohort study was performed using the Secondary Uses Service (SUS) electronic database for people aged 75 or older admitted between April 2017 and March 2018. METHODS: Based on HFRS, the populations were risk stratified into mild, moderate and severe frailty risk. The relationships with length of stay, readmission rate, mortality and some selected condition specific treatment complications were quantified using descriptive statistics. RESULTS: Very few individuals (<2%) could not be risk stratified for frailty risk. Frailty was differentially distributed across the specialties; around one-third had mild frailty; another third had moderate frailty and one-quarter severe frailty. Increasing frailty risk was associated with increased length of stay for the index admission, more days in hospital in the year following intervention and increased risk of dying in hospital. Severe frailty was a powerful discriminator of the risk of death; between 25 and 40% of those with severe frailty risk died at 30 months across all specialties. CONCLUSIONS: This study demonstrates the first application of the HFRS to a national dataset to describe service outcomes and mortality for older people undergoing a range of specialised interventions. This information could be used to identify those that might benefit from holistic assessment, aid prognostication, commissioning and service planning.

Phaeochromocytoma presenting as an acute coronary syndrome.

A 44-year-old Caucasian man presented to the emergency department in acute cardiogenic shock, with pulmonary oedema, secondary to an acute myocardial infarction and in a hyperosmolar hyperglycaemic state. The previous day he had undergone a colonoscopy, which revealed features of colitis, and was started on prednisolone. He had been previously diagnosed with type 2 diabetes, migraine and anxiety attacks. While awaiting a coronary angiogram he developed abdominal pain and a CT scan was performed and found a large right adrenal mass. Plasma-free metadrenaline levels were elevated. After 4 months, a right adrenalectomy was performed successfully. He made a good recovery with normalisation of his heart function and resolution of his diabetes. The diagnosis was delayed for years due to his episodic symptoms being attributed to other more common diagnoses. Although a rare diagnosis in itself, there are case reports of phaeochromocytoma initially presenting with an acute coronary syndrome.