Frailty Status as a Novel Risk Stratification Tool in Patients with Acute Pancreatitis.

Background: Although frailty is a known predictor of mortality and complications across various disease states, it remains an understudied topic among patients with acute pancreatitis (AP).

Objectives: Our aim was to assess the impact of frailty on outcomes in patients with AP.

Design: Retrospective cohort study.

Setting: Appended data was obtained from the 2016-2017 National Inpatient Sample (NIS) database.

Participants: 574,895 adult patients with a primary discharge diagnosis of AP.

Measurements: We performed a nationwide cohort study utilizing International Classification of Diseases (ICD) diagnostic codes to identify adult patients with AP. The Hospital Frailty Risk Score (HFRS) was used to classify patients as frail or non-frail. The primary outcome was complications related to AP including all-cause mortality. Secondary outcomes were length of stay and total hospitalization costs. Multivariable logistic regression models were used to determine the association between frailty and complications.

Results: 574,895 patients were represented; 24.7% (141,999) characterized as frail and 75.3% (432,896) as non-frail. 26.7% of frail patients suffered composite complications related to AP versus 13.3% of non-frail patients (P < 0.001). Frail patients had more cardiovascular, pulmonary, gastrointestinal, and infectious adverse events compared to non-frail patients. Frail patients also had higher mortality rates (2.0% vs 0.1% P < 0.001), increased length of stay (6.5 days vs 3.6, P < 0.001) and total hospitalization charges ($60,136 vs $31,095, P < 0.001). On multivariable analysis, positive frailty status was associated with 2.33 times increased odds of having composite complications.

Conclusions: Frailty assessments can be utilized as an adjunct to validated scoring systems to improve risk stratification and clinical management of patients with AP.