The Association Between the Risk Analysis Index of Frailty and Patient Safety Indicators: A Single-System Cohort...

Frailty is associated with adverse outcomes among hospitalized patients; however, its relationship to patient safety indicators (PSIs) and inpatient medical costs is poorly understood. Our study aims to assess the association between the Risk Analysis Index frailty measure and each of the 13 PSI events most pertinent to surgical treatment and estimate the average cost of PSI events per at-risk encounter.

A retrospective cohort analysis utilized inpatient and outpatient electronic health records from a single, multi-hospital, health-care system. The cohort included all adult inpatient (age ≥ 18 y) encounters who were at risk for specific, adverse PSI events with a valid, antecedent Risk Analysis Index value. Univariate unadjusted logistic regression models generated odds ratios (ORs) with 95% confidence intervals stratified by frailty level. Secondary outcomes estimated costs per individual events in the PSI-90 composite index.

Frailty was associated with significantly higher odds of several adverse PSI events, specifically postoperative sepsis (very frail OR 3.11 95% Cl 2.17-4.47), postoperative acute kidney injury requiring dialysis (very frail OR 2.97 95% Cl 1.55-5.70), and postoperative respiratory failure (frail OR 1.45 95% Cl 1.04-2.04). Average estimated cost per at-risk encounter for individual PSI events increased with patient frailty, totaling $4,049,431.00 per year across the health-care system.

Frailty is associated with both increased rates and costs of PSI events that directly inform financial penalties in the Hospital-Acquired Condition Reduction Program. Reassessment of Hospital-Acquired Condition Reduction Program component metrics may be warranted to avoid overpenalization of hospitals caring for disproportionately frail populations.