Effect of Frailty on Healthcare Resource Utilization in Patients Undergoing Elective Endovascular Treatment for Intracranial Aneurysms

Introduction: To examine how frailty, measured by the Hospital Frailty Risk Score (HFRS), affects healthcare resource utilization in patients undergoing elective endovascular treatment for unruptured intracranial aneurysms (IAs).

Methods: We conducted a retrospective cohort study using data from the Health Services Cost Review Commission (HSCRC) database from 2013 to 2020. The study included all adult patients (>18 yrs) who underwent elective endovascular treatment for IAs, identified through ICD-10-CM codes. Patients were classified into frailty categories based on the HFRS: low (HFRS < 5), intermediate (HFRS 5–15), and high (HFRS >15). Patient demographics, adverse events, length of stay (LOS), discharge status, and total hospitalization costs were collected. Multivariate logistic regression analysis was performed to determine independent predictors of extended LOS and elevated costs.

Results: Of the 927 patients analyzed, 591 (63.7%) were classified as low frailty, 324 (34.9%) as intermediate frailty, and 12 (1.3%) as high frailty based on the HFRS. The rates of adverse event rates increased significantly across these groups, with higher frailty associated with a greater incidence (low: 4.4%; intermediate: 15.1%; high: 58.3%; p< 0.001). There was a progressive increase in both the mean LOS and total hospital cost with rising frailty levels: mean LOS was 1.7±1.8 days in the low frailty group, 2.7±4.0 days in the intermediate group, and 27.3±40.1 days in the high frailty group (p < 0.001). Likewise, the average total cost was $55,962±29,688 for low frailty, $60,106±33,760 for intermediate, and $142,729±105,831 for high frailty group (p < 0.001). Multivariate regression analysis indicated that higher frailty levels were significantly associated with extended LOS (intermediate frailty: OR 1.37, p< 0.001; high frailty: OR 7.86, p< 0.001) and increased total cost (high frailty: OR 1.78, p< 0.001). Additionally, any adverse event and being married were independent predictors of higher hospital costs (p < 0.05).

Conclusion : Our study revealed that higher frailty, was linked to longer hospital stays and greater total costs. Recognizing frail patients early and tailoring treatment strategies to their needs can enhance the efficiency of healthcare resource allocation.