Hospital Frailty risk score is an independent predictor of outcomes in cutaneous Squamous cell carcinomas of Head and Neck region.

Presentation: A156
Topic: Skin Cancer
Type: Poster
Date:
Session:
Authors: Rema A Kandula, MD; Sandeep Kandregula, MD; Bharat Guthikonda, MD; John Pang, MD; Ameya Asarkar, MD; Cherie-Ann O Nathan, MD
Institution(s): LSU Health sciences Shreveport


Importance:

The demographics of cutaneous squamous cell carcinoma of the head and neck (cSCCHN) is marked by a growing number of patients age 65 and over significantly contributing to the overall disease burden in the elderly. Frailty index is a well-studied concept defined by age-related decline in physiological reserve, which could be a reliable clinical assessment tool to provide prognostic information and outcomes thus allowing for improved treatment planning.


Objective:

In this study, we explored the effect of frailty on short-term outcomes and hospital costs and compared it with age as an independent predictor through the NIS database.

Materials and Methods: We queried the NIS database for the diagnosis of Cutaneous Squamous cell carcinomas of the Head and Neck region from the years 2016 to 2018 (3 years). Frailty was assessed through Hospital Frailty Risk score (HFRS) which provides a numerical score for each patient. All the patients were categorized as low risk (0-5), intermediate risk (5-15) and high-risk of frailty group (>15). The outcomes analyzed were death in hospital, complications, extended length of stay and non-home discharge.

Results: A total of 6715 patients with cSCCHN underwent surgical excision within hospital stay. Based on HFRS, 74.2 % were in the low risk, 23.7 % in the intermediate risk and 2.1% fell in the high-risk frailty groups. The mean age in the low-risk group (non-frail) was 71.92 years (SD +11.58), 74.14 years (SD 11.75) in the intermediate-risk group, and 76.32 years (SD 9.38) in the high-risk group (p<0.001). Males were predominant in all groups (p=0.509). Caucasians were the predominant population in all the groups. The most common insurance was Medicare across all groups. The mean ECI score (comorbidities) increased significantly across the groups (11.04, 20.30, 24.46), and were significantly different from each other (p<0.001). The mean hospital charges for the low risk group were $ 96,100, whereas the frail group (high risk) was $ 167,140 (p = 0.003).

The death rate was seven times higher in the high-risk frailty group (7.1%) compared to low-risk group (0.5%). Non-home discharge increased with increase in the frailty score. Extended length of stay was present in 64.3% in the high-risk frail group vs 10.9% in the low-risk frail group (10.9%) (p<0.001). 75% of the high-risk frail patients had at least one complication vs 7.1% in the low-risk frail group (p<0.001). Patients with higher comorbidity score (adjusted OR 1.067, 95% CI 1.026-1.109, p<0.001) and frailty score (adjusted OR 1.102, 95% CI 1.042-1.165, p<0.001) had increased odds of in-hospital death, while age and gender did not predict death. ROC curves revealed higher discriminating capacity for frailty compared to age and comorbidity score for all the outcome variables (Fig 1-4).

Conclusion: Our study shows that frailty is an independent predictor that can affect perioperative morbidity, mortality, length of stay, and hospital costs. Classifying patients by their functional status using the frailty scale identifies at-risk patients in the pre-operative clinic and can aid clinicians in counseling patients and families about the hospital course and anticipated complications.