Hidden Dangers of Frailty: Higher Mortality, Complications and Costs in Acute Pancreatitis

Authors

Nishit Patel, Department of Gastroenterology, St Luke’s University Health Network, 701 ostrum street, Bethlehem, PA, 18015, USA
Janak Bahirwani, Department of Gastroenterology, St Luke’s University Health Network, 701 ostrum street, Bethlehem, PA, 18015, USA
Krishna Bodrya, Department of Medicine, Lehigh Valley Health Network, Allentown, PA, USA
Dhruvanshu Patel, Department of Medicine, St Luke’s University Health Network, Bethlehem, PA, USA
Yechskel Schneider, Department of Gastroenterology, St Luke’s University Health Network, 701 ostrum street, Bethlehem, PA, 18015, USA

Document Type

Article

Abstract

Background: Frailty is a clinically recognizable state of increased vulnerability due to age-related decline in reserve and function across multiple physiologic systems that compromises the ability to cope with acute stress. As frailty is being identified as an important risk factor in outcomes of gastrointestinal pathologies, we aimed to assess outcomes in patients with acute pancreatitis within this cohort.

Method: We conducted a retrospective study using the Nationwide Inpatient Sample (NIS) database. ICD-10 codes were used to inquire for patients admitted with acute pancreatitis between September 2015 through 2017. ICD-10 codes corresponding to the Hospital Frailty Risk Score (HFRS) were used to divide the study sample into 2 cohorts: low risk (< 5 points) and intermediate or high risk (> 5 points). To calculate the points, we fitted a logistic regression model that included membership of the frail group as the binary dependent variable (frail vs. non-frail) and the set of ICD-10 codes as binary predictor variables (1 = present, 0 = absent for each code). To simplify the calculation and interpretation, we multiplied regression coefficients by five to create a points system, so that a certain number of points are awarded for each ICD-10 code and added together to create the final frailty risk score. Multivariate regression analysis was performed to find adjusted mortality.

Results: Out of a total of 1,267,744 patients admitted with acute pancreatitis, 728,953 (57.5%) were identified as intermediate and high risk (> 5 points) (study cohort) and 538,781 (42.5%) as low risk (< 5 points). The mean age in the study cohort was 64.8 ± 12.6 and that in the low-risk group was 58.6 ± 9.5. Most of the patients in both groups were males and Caucasians; Medicare was the predominant insurance provider. A majority of the admissions in both groups were in an urban teaching hospital and were emergency. (Table 1). The primary outcome was in-hospital mortality which was significantly higher in the study cohort as compared to the low-risk group (4.3% vs. 2.5%, p < 0.0001). The age-adjusted Odds ratio of mortality was 1.72(95% CI (Confidence Interval) 1.65–1.80, p < 0.05). When compared between the two groups; median length of stay (6 vs. 4); hospitalization cost ($14,412 vs. $10,193), disposition to a skilled nursing facility (SNF) (17.1% vs. 8.6%) and need for home health care (HHC) was significantly higher in the study cohort. Complications like septicemia, septic shock, and acute kidney injury were also higher in the study group.

Conclusion: Using frailty as a construct to identify those who are at greater risk for adverse outcomes, can help formulate interventions to target individualized reversible factors to improve outcomes in patients with acute pancreatitis. Future large-scale prospective studies are warranted to understand the dynamic and longitudinal relationship between pancreatitis and frailty.

First Page

3188

Last Page

3194

DOI

10.1007/s10620-024-08480-z

Publication Date

5-24-2024

Recommended Citation

Patel N, Bahirwani J, Bodrya K, Patel D, Schneider Y. Hidden dangers of frailty: higher mortality, complications and costs in acute pancreatitis. Digestive Diseases and Sciences. 2024 Sep;69(9):3188-94.