Abstract
Introduction
To understand the effects of frailty on hospital outcomes such as in-hospital mortality,
length of stay, and healthcare cost among patients with cancer using a nationally
representative database.
Materials and Methods
This study was a retrospective observational analysis of Nationwide Inpatient Sample
(NIS) data collected during 2005–2014. Participants included adult patients with cancer
≥45 years identified by International Classification of Diseases, Ninth Revision,
Clinical Modification (ICD-9-CM) codes. ‘Frail’ versus ‘non-frail’ hospitalizations
were determined using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining
diagnosis indicator. Main outcome measures were in-hospital mortality, hospital length
of stay, and hospitalization cost. We defined prolonged length of stay as hospital
stay ≥75th percentile of the study sample. Propensity score match analysis was done
to examine whether frailty was associated with length of stay and in-hospital mortality.
Results
There were 10,463,083 cancer hospitalizations during 2005–2014, of which 1,022,777
(9.8%) were frail. Patients having length of stay ≥8 days were significantly higher
among frail group, compared to non-frail group (53.3% versus 25.3%, P < 0.001). Similarly,
unadjusted mortality (12.0% versus 5.3%, P < 0.001) and hospitalization costs ($29,726
versus $18,595, P < 0.001) were significantly higher for frail patients. Nearly $28
billion was expended on hospitalization of frail patients with cancer during the study
period. In propensity score match analysis, the odds of in-hospital mortality (odds
ratio [OR], 1.54; 95% confidence interval [CI], 1.50–1.58) and length of stay (OR,
2.23; 95% CI, 2.18–2.27) were significantly greater for frail patients.
Discussion
Frailty was associated with adverse hospital outcomes such as increased length of
stay, mortality, and hospitalization cost among all cancer types. Our findings could
be valuable for frailty-based risk stratification of patients with cancer. Concerted
efforts by the physiatrists, oncologists, and surgeons towards identifying frailty
and incorporating it in risk estimation measures could help in optimizing management
strategies for cancer.
Keywords
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Article info
Publication history
Published online: June 22, 2022
Accepted:
June 17,
2022
Received in revised form:
June 12,
2022
Received:
March 13,
2022
Identification
Copyright
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