Hospital Frailty Risk Score and outcomes after cervical disc arthroplasty: analysis of US National Readmissions Database.

Abstract

Cervical disc arthroplasty (CDA) is an emerging procedure aimed at addressing cervical disc degeneration while preserving motion at the affected spinal segment. This study examined how frailty, measured by the Hospital Frailty Risk Score (HFRS), affects in-hospital outcomes and readmissions post-CDA. The authors conducted an analysis of the US Nationwide Readmissions Database (2016-020) for adults undergoing CDA. Patients were categorized by HFRS into higher and lower risk groups. The study outcomes included in-hospital mortality, complications, and readmission rates at 30 and 90 days. Propensity score matching and logistic regression analyses were used to determine the associations. After matching, data from 1017 patients (higher frailty risk: 339; lower frailty risk: 678) were analyzed, representing a total of 1726 individuals in the entire US after weighting. Compared with patients at lower risk, those at higher frailty risk had significantly higher risks of complications (OR 3.57, 95% CI 2.60-4.91). Specific complications included dysphagia (OR 3.79, 95% CI 2.41-5.96), infections (OR 2.56, 95% CI 1.55-4.24), urinary tract infections (OR 5.97, 95% CI 2.94-12.15), and cerebrovascular accidents (CVAs; OR 8.03, 95% CI 3.58-18.02) (all p < 0.001). However, frailty did not significantly affect 30-day or 90-day readmission rates. The most frequent readmission diagnoses were spondylopathies (30-day: 17.2%; 90-day: 24.2%), followed by complications of other surgical or medical care, and septicemia. This study shows that frailty, assessed by HFRS, significantly raises the risk of postoperative complications in patients undergoing CDA in US hospitals. These findings emphasize the need for preoperative evaluation of frailty for optimizing postsurgical care.