P0621 - The Hospital Frailty Risk Score as a Predictor of Readmission After ERCP

Khanh Le, BS, MS¹, Alexander Qian, BS², Mimi V. Nguyen, BS³, Edmund M. Qiao, BS⁴, Phuong Nguyen, MD⁵, Mary L. Krinsky, DO^6
1Tufts University School of Medicine, Boston, MA; ²UCSD School of Medicine, La Jolla, CA; ³UCSD, La Jolla, CA; ⁴UC San Diego, La Jolla, CA; ⁵Hoag Hospital, Newport Beach, CA; ⁶University of California San Diego School of Medicine, La Jolla, CA

Introduction: The 30-day hospital readmission rate is a nationally recognized quality measure with nearly one-fifth of admitted patients being readmitted. Studies have created models to risk stratify patients for mortality after ERCP, but none have studied risk stratification for readmissions after ERCP. This study evaluates risk-factors for 30-day readmissions after inpatient ERCP, including the Hospital Frailty Risk Score (HFRS), a validated ICD-10 dependent scoring system.

Methods: We analyzed the 2017 Nationwide Readmissions Database from 116 medical centers to identify admitted patients who underwent an ERCP between 01/01/2017 to 11/30/2017. Our primary outcome was the 30-day unplanned readmission rate when comparing frail (defined as HFRS > 5) against non-frail (HFRS < 5) patients. Additional outcomes of interest include hospital length of stay (LOS), hospitalization charges, risk factors, and indications for readmission. A mixed effects multivariable logistic regression method was employed.

Results: Among 68,206 weighted hospitalized patients undergoing ERCP, 31.3% were frail. Frailty was associated with higher 30-day readmission (16.5% vs 10.9%, p < 0.01), and with multivariate modeling (OR 1.35, 95% CI [1.28 - 1.43]). Multivariable analysis also showed a greater risk of readmission in patients with liver transplantation (OR = 1.72, 95% CI [1.37 - 2.17]), cirrhosis (OR = 1.49, 95% CI [1.30 - 1.71]), cancer (OR = 2.27, 95% CI [2.15 - 2.41]) and in males (OR = 1.41, 95% CI [1.19 - 1.32]). Frail patients spent more days in the hospital during their readmission (6.1 vs 5.3 days, p < 0.01) and incurred more charges from both hospitalizations ($175,620 vs $132,519, p < 0.01). Sepsis was the primary indication for both frail and non-frail readmissions and accounted for a significantly greater percentage of frail readmissions (17.9% vs 12.4%, p < 0.01).

Discussion: Frailty is associated with higher readmission rates, LOS, and hospital charges for admitted patients undergoing ERCP. In addition, independent risk factors include liver transplantation, cancer, cirrhosis, and male gender. Sepsis is the leading cause for readmission. In hospitalized patients undergoing ERCP, these findings should be considered to guide management strategies that reduce the risk of readmission and sepsis.


Disclosures:


Khanh Le, BS, MS¹, Alexander Qian, BS², Mimi V. Nguyen, BS³, Edmund M. Qiao, BS⁴, Phuong Nguyen, MD⁵, Mary L. Krinsky, DO⁶. P0621 - The Hospital Frailty Risk Score as a Predictor of Readmission After ERCP, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.