Association of frailty with clinical and financial outcomes of esophagectomy hospitalizations in the United States

Abstract

Background: Frailty, defined as impaired physiologic reserve and function, has been associated with inferior results after surgery. Using a coding-based tool, we examined the clinical and financial impact of frailty on outcomes following esophagectomy. Methods: Adults undergoing elective esophagectomy were identified using the 2010–2018 Nationwide Readmissions Database. Using the binary Johns Hopkins Adjusted Clinical Groups frailty indicator, patients were classified as frail or nonfrail. Multivariable regression models were used to evaluate the association of frailty with in-hospital mortality, complications, hospitalization duration, costs, nonhome discharge, and unplanned 30-day readmission. Results: Of 45,361 patients who underwent esophagectomy, 18.7% were considered frail. Most frail patients were found to have diagnoses of malnutrition (70%) or weight loss (15%) at the time of surgery. After adjustment, frailty was associated with increased risk of in-hospital mortality (adjusted odds ratio 1.67, 95% confidence interval 1.29–2.16) and overall complications (adjusted odds ratio 1.57, 95% confidence interval 1.44–1.71). Frailty conferred a 5.6-day increment in length of stay (95% confidence interval 4.94–6.45) and an additional $19,900 hospitalization cost (95% confidence interval $16,700–$23,100). Frail patients had increased odds of nonhome discharge (adjusted odds ratio 1.53, 95% confidence interval 1.35–1.75) as well as unplanned 30-day readmissions (adjusted odds ratio 1.17, 95% confidence interval 1.02–1.34). Conclusion: Frailty, as detected by an administrative tool, is associated with worse clinical and financial outcomes following esophagectomy. The inclusion of standardized assessment of frailty in risk models may better inform patient selection and shared decision-making prior to operative intervention.