Brigham and Women's Hospital Boston, Massachusetts
Introduction: The impact of frailty on patients with chronic pancreatitis has not been studied previously. This study aimed to assess the prevalence and impact of frailty on mortality, readmission rates, and healthcare utilization among hospitalized chronic pancreatitis patients in the United States.
Methods: : A retrospective cohort study using Nationwide Readmission Database (NRD) on chronic pancreatitis patients with index admissions from Jan 1st, 2019, to June 30th, 2019. These patients were followed till Dec 31st, 2019, in the database. We applied a previously validated hospital frailty risk scoring system to classify chronic pancreatitis patients into frail (score of ≥ 5) and non-frail (score of < 5) on index hospitalization and compared the characteristics of frail and non-frail patients. The primary outcomes of this study were mortality and readmission rates at 6 months. The secondary outcomes included (1) time to death and readmission from discharge after index hospitalization (2) hospitalization characteristics (3) causes of readmission (4) healthcare utilization.
Results: Of 56,072 eligible patients, 41.37% were classified as frail. A total of 65.8% of frail patients were of age less than 65 years, and 32.7% had none or only one comorbidity. Frail patients experienced a higher rate of unplanned and preventable hospitalizations (Table 1). On multivariate analysis, frailty was independently associated with higher mortality risk (adjusted hazard ratio [aHR], 2.05; 95% CI, 1.7–2.5) (fig 1a). Frailty was also associated with a higher risk of all-cause readmission with an aHR of 1.07; (95% CI, 1.03–1.1) (fig 1b). The mean time to death (28.3 days (24.5-32) vs 48 (37-59)) and to readmission (56.7 days (55.4-58; p< 0.001) vs 59.3 (58-61; p< 0.001) was significantly shorter among frail patients. The infectious causes were the most common cause of readmission among frail patients (16.8%) compared to acute pancreatitis among non-frail patients (32.3%) Table 1. Frail patients experienced a longer length of stay (7.21 days vs 4.11 days), higher hospitalization costs ($18,705 vs $9918), and hospitalization charges ($78,527 vs $41,927).
Discussion: Among hospitalized chronic pancreatitis patients, frailty was independently associated with a higher risk of readmissions and mortality at 6 months. Frail patients also accounted for significantly higher health resource utilization in the United States.
