S1146 Impact of Frailty on ERCP Outcomes

Abstract

Introduction: Frailty has been recognized as an important risk factor and predictor of mortality and adverse events in the inpatient setting. It has not been studied as a tool to assess risk among patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP). We aim to determine the association between frailty and risk of adverse events in hospitalized patients undergoing ERCP. Methods: We conducted a cohort study using the 2017 Nation Inpatient Sample database, using International Classification of Diseases (ICD) diagnostic codes to identify adult patients who underwent ERCP and the Hospital Frailty Risk Score (HFRS) to classify patients as Frail or non- Frail. HFRS is a validated algorithm of ICD-10 codes. Multivariable analysis logistic regression was performed for outcomes of frail patients compare to non frail patients Results: 216,775 hospitalizations met inclusion criteria, of which 31.7% (68,555) were identified as frail and 68.3% (148,220) as non-frail. Baseline characteristics of both groups are compared in Table. Frail patients had worse post procedure complications including post ERCP pancreatitis (7.3% vs 3.4%, p < .001), perforation (1.2% vs 0.4%, p < .001), bleeding (0.8% vs 0.3%, p < .001) and peritonitis (1.2% vs 0.3%, p < .001). Frail patients had more cardiovascular (22.2% vs 5.5%, P < .001), pulmonary (22.1% vs 4.7%, P < .001), GI (25.9% vs 19.8%, P < .001) and infectious (39.2% vs 4.6%) adverse events compared with non-frail patients. Frail patients also had higher ICU admission (8.5% vs 0.5%, p < .001), increased length of stay (9.3 days vs 4.3 days, p < .001), more total charges (118,875$ vs 62,386$, p< .001) and higher all-cause inpatient mortality rates (4.2 % vs 0%, P < 0.001 as compared to non-frail. When adjusted for age, gender, race, hospital location, teaching status, insurance, median household income and Charlson co-morbidity index frail patients were had a higher risk of cardiac[OR 2.29 (95% CI 2.12-2.46), p< 0.001], pulmonary[OR 4.9 (95% CI 4.52-5.31), p< 0.001], infectious[OR 12.83 (95% CI 11.85-13.88), p< 0.001], GI [OR 1.68 (95% CI1.58-1.77), p< 0.001] adverse events as well as inpatient mortality[OR 9.93 (95% CI 7.3-13.3), p< 0.001] as compared to non-frail. Conclusion: In hospitalized patients undergoing ERCP, frailty status is associated with increased adverse events including all-cause mortality. The use of frailty assessments can further guide clinical decision-making when considering ERCP and the risk of adverse events in adult patients. Table 1. - Baseline characteristics and outcomes of the frail and non-frail groups undergoing ERCP Variable ERCP + Not Frail n=148,220 ERCP + Frail * n= 68,555 p-value Female, % 59.69 52.61 < 0.001 Age (years), mean ± SD 55.87 ± 18.93 69.37 ± 15.35 < 0.001 Age >=65 years, % 37.20 67.85 < 0.001 Race, % < 0.001 White 65.18 70.06 Black 9.21 10.58 Hispanic 17.38 11.67 Other 8.24 7.70 Charlson co-morbidity index, mean ± SD 1.33 ± 1.98 3.11 ± 2.59 < 0.001 Hospital Frailty Risk Score, mean ± SD 1.71 ± 1.55 8.56 ± 3.14 < 0.001 In-hospital all-cause mortality, % 0.25 4.20 < 0.001 Length of Stay (Days), mean ± SD 4.37 ± 3.80 9.39 ± 10.32 < 0.001 Total Charges ($), mean ± SD 62,386.77 ± 50,903.26 118,875.9 ± 175,602 < 0.001 Post Procedure complications, % Post-ERCP pancreatitis 3.44 7.38 < 0.001 Perforation 0.43 1.28 < 0.001 Bleeding 0.31 0.81 < 0.001 Peritonitis 0.29 1.25 < 0.001 Cardiac complications, % 5.50 22.19 < 0.001 Pulmonary complications, % 4.75 22.11 < 0.001 GI complications, % 19.82 25.95 < 0.001 ID complications, % 4.59 39.23 < 0.001 Anesthesia and drug-related complications, % 0.02 0.08 0.001 Required Intensive Care Unit, % 0.53 8.56 < 0.001 Multivariate Regression for the Outcomes # Outcome Adjusted Odds Ratio (FrailERCP vs NonFrailERCP) 95% CI p-value In-hospital mortality 9.93 [7.38 – 13.35] < 0.001 Length of Stay (Days) 4.53 & [4.28 – 4.77] < 0.001 Total Charges ($) 54,659.9$ & [50,176.52$ – 59,143.28$] < 0.001 Cardiac complications 2.29 [2.12 – 2.46] < 0.001 Pulmonary complications 4.90 [4.52 – 5.31] < 0.001 GI complications 1.68 [1.58 – 1.77] < 0.001 ID complications 12.83 [11.85 – 13.88] < 0.001 Anesthesia and drug-related complications 3.68 [2.13 – 15.13] 0.001 Required Intensive Care Unit 17.19 [13.99 – 21.13] < 0.001 *Frail =Hospital Frailty Risk Score (HFRS)≥5.#Analysis adjusted for age, gender, race, hospital location and teaching status, insurance, median household income and Charlosn co-morbidity index.&Adjusted co-efficient representing the average difference in this outcome between FrailERCP and NonFrailERCP.