Chart-Review Based Frailty Assessment Can Predict Readmission after Lung Transplantation: A Pilot Study

Abstract

Chart-based frailty assessment is an attractive option for evaluation of older transplant candidates, as it has been shown to be predictive of morbidity and mortality in the community-dwelling elderly population. We proposed to evaluate frailty in lung transplant candidates to determine whether retrospective frailty could be calculated, and whether it was associated with patient outcomes after transplantation. In this retrospective study, in a previously evaluated cohort of lung transplant recipients, Frailty Risk Score (FRS) as described by Lekan et al. was calculated using a standardized assessment tool. Electronic medical record notes from pulmonologists, psychiatrists, and social workers; laboratory measures, and ICD-10 codes were reviewed. Length of hospitalization, number of readmissions, and time in hospital during the first year after transplantation were assessed. High FRS was defined as >3. 31 subjects were reviewed. The median age was 63 (range 42-77). Median FRS was 3 (range 1-7). The most common positive FRS components were dyspnea, fatigue, chronic pain, depression, and abnormal WBC. 21 patients (68%) were readmitted in the first year after transplantation, for a median of 1 readmission per patient (range 0-5). Patients spent a median of 19 days inpatient during the first year (range 7-82). There was no association between FRS and patient age (p=0.983). A significant association was seen between readmission and FRS, both by numeric score (p<0.001) and by FRS high versus low assessment (p=0.004) (Figure). FRS was also significantly associated with inpatient days by FRS high versus low assessment (p=0.020) (Figure). Chart based frailty and comorbidity assessments can be readily performed in previous lung transplant recipients. Frailty as measured by FRS score was able to predict need for readmission and length of total inpatient hospitalizations, suggesting its promise as a tool for patient risk stratification.