Association of frailty with clinical and financial outcomes of hospitalization for non-operative trauma

Abstract

Background: With advances in imaging and interventional techniques, traumatic injuries are increasingly managed non-operatively. However, the impact of frailty on outcomes of non-operatively managed traumatic injuries remains generally unexplored. Using a national cohort, we characterized the association of frailty with clinical and financial outcomes of non-operative trauma hospitalizations. Methods: We identified all adult (≥18 years) hospitalizations for traumatic injuries using the 2019–2021 Nationwide Readmissions Database. Only patients who did not undergo major operations were considered. Patients were then stratified into three frailty groups based on the validated Hospital Frailty Risk Score. Multivariable models were subsequently developed to assess the association of frailty with various clinical and financial outcomes. Results: Of an estimated 2,818,070 hospitalizations for non-operative trauma, 18.6 % were classified as low frailty (LF), 57.0 % as intermediate frailty (IF), and 24.4 % as high frailty (HF). Following risk adjustment, compared to LF, IF (Adjusted Odds Ratio [AOR] 2.4; 95 % Confidence Interval [CI], 2.0–3.0) and HF (AOR 3.3; 95 % CI, 2.7–4.1) were associated with greater odds of in-hospital mortality. Similarly, risks of major complications and non-home discharge elevated in a stepwise fashion. Furthermore, IF patients experienced an incremental increase in LOS of 1.3 days (95%CI, 1.2–1.4 days) and costs of $3200 (95 % CI, $3100–$3400) while HF patients had a prolonged LOS by 5.1 days (95 % CI, 4.8–5.2 days) and higher costs by $11,300 (95 % CI, $11,000-11,600). Conclusion: Our findings showed frailty status to be associated with adverse clinical outcomes and increase resource utilization among hospitalizations for non-operative trauma.

Keywords

• Frailty
• Non-operative management
• Trauma
• National Readmission Database