Association of frailty with postoperative outcomes following thoracic transplantation: A national analysisCentral MessagePerspective
Shineui Kim, BA,
Sara Sakowitz, MS, MPH,
Joseph Hadaya, MD, PhD,
Joanna Curry, BA,
Nikhil L. Chervu, MS, MD,
Syed Shahyan Bakhtiyar, MD,
Saad Mallick, MD,
Nam Yong Cho, BS,
Peyman Benharash, MD
Affiliations
Shineui Kim, BA
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
Sara Sakowitz, MS, MPH
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
Joseph Hadaya, MD, PhD
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif; Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, Calif
Joanna Curry, BA
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
Nikhil L. Chervu, MS, MD
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif; Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, Calif
Syed Shahyan Bakhtiyar, MD
Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, Colo
Saad Mallick, MD
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
Nam Yong Cho, BS
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
Peyman Benharash, MD
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif; Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, Calif; Address for reprints: Peyman Benharash, MD, UCLA Division of Cardiac Surgery, 62-249 Center for Health Sciences, Los Angeles, CA 90095.
Objective: Frailty has been repeatedly associated with inferior outcomes after surgical hospitalizations. However, a thorough evaluation of the impact of frailty on the clinical and financial outcomes of patients undergoing solid-organ thoracic transplantation is sparse in the literature. We evaluated the association of frailty, as determined by an administrative tool, with postoperative outcomes and healthcare resource use after heart or lung transplantation. Methods: The Nationwide Readmissions Database was used to identify all adult hospitalizations for heart or lung transplant from 2014 to 2020. Patients were grouped as frail or nonfrail using International Classification of Diseases codes associated with conditions in the Johns Hopkins Adjusted Clinical Groups cluster. Multivariable regression models were developed to evaluate the association of frailty status on in-hospital mortality, complications, length of stay, costs, and unplanned readmissions. Results: Of an estimated 35,862 heart or lung transplant recipients, 7316 (20.4%) were considered frail. After multivariable adjustment, frailty in heart transplantation was associated with greater odds of in-hospital mortality (adjusted odds ratio, 1.54; 95% CI, 1.19-1.99) and infectious complications (adjusted odds ratio, 1.77; 95% CI, 1.45-2.15; P < .001). Frailty in lung transplantation was also associated with higher odds of in-hospital mortality (adjusted odds ratio, 1.38; 95% CI, 1.11-1.69) and infectious complications (adjusted odds ratio, 1.93; 95% CI, 1.60-2.31). In addition, frailty in both heart transplantation and lung transplantation was associated with increased postoperative length of stay and greater costs. Conclusions: Among transplant recipients, those classified as frail were associated with increased in-hospital mortality, perioperative complications, and resource use.
