B0459 - Impact of Frailty on ERCP Outcomes

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Ahmad Nawaz, MD

Yale University School of Medicine
New Haven, CT

Ahmad Nawaz, MD¹, Abdelkader Chaar, MD¹, Rabia Rizwan, MD¹, Dania Abdulkarim, MD², Fatima Khalid, ³, Thiruvengadam Muniraj, MD, PhD¹
¹Yale University School of Medicine, New Haven, CT; ²University of Aleppo, Milford, CT; ³FMH College of Medicine & Dentistry, Lahore, Punjab, Pakistan

Introduction: Frailty has been recognized as an important risk factor and predictor of mortality and adverse events in the inpatient setting. It has not been studied as a tool to assess risk among patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP). We aim to determine the association between frailty and risk of adverse events in hospitalized patients undergoing ERCP.

Methods: We conducted a cohort study using the 2017 Nation Inpatient Sample database, using International Classification of Diseases (ICD) diagnostic codes to identify adult patients who underwent ERCP and the Hospital Frailty Risk Score (HFRS) to classify patients as Frail or non- Frail. HFRS is a validated algorithm of ICD-10 codes. Multivariable analysis logistic regression was performed for outcomes of frail patients compare to non frail patients

Results: 216,775 hospitalizations met inclusion criteria, of which 31.7% (68,555) were identified as frail and 68.3% (148,220) as non-frail. Baseline characteristics of both groups are compared in table 1. Frail patients had worse post procedure complications including post ERCP pancreatitis (7.3% vs 3.4%, p < .001), perforation (1.2% vs 0.4%, p < .001), bleeding (0.8% vs 0.3%, p < .001) and peritonitis (1.2% vs 0.3%, p < .001). Frail patients had more cardiovascular (22.2% vs 5.5%, P < .001), pulmonary (22.1% vs 4.7%, P < .001), GI (25.9% vs 19.8%, P < .001) and infectious (39.2% vs 4.6%) adverse events compared with non-frail patients. Frail patients also had higher ICU admission (8.5% vs 0.5%, p < .001), increased length of stay (9.3 days vs 4.3 days, p < .001), more total charges (118,875$ vs 62,386$, p< .001) and higher all-cause inpatient mortality rates (4.2 % vs 0%, P < 0.001 as compared to non-frail. When adjusted for age, gender, race, hospital location, teaching status, insurance, median household income and Charlson co-morbidity index frail patients were had a higher risk of cardiac[OR 2.29 (95% CI 2.12-2.46), p< 0.001], pulmonary[OR 4.9 (95% CI 4.52-5.31), p< 0.001], infectious[OR 12.83 (95% CI 11.85-13.88), p< 0.001], GI [OR 1.68 (95% CI1.58-1.77), p< 0.001] adverse events as well as inpatient mortality[OR 9.93 (95% CI 7.3-13.3), p< 0.001] as compared to non-frail.

Discussion: In hospitalized patients undergoing ERCP, frailty status is associated with increased adverse events including all-cause mortality. The use of frailty assessments can further guide clinical decision-making when considering ERCP and the risk of adverse events in adult patients

Variable	ERCP + Not Frail n=148,220	ERCP + Frail^* n= 68,555	p-value
Female, %	59.69	52.61	< 0.001
Age (years), mean ± SD	55.87 ± 18.93	69.37 ± 15.35	< 0.001
Age >=65 years, %	37.20	67.85	< 0.001
Race, %			< 0.001
White	65.18	70.06
Black	9.21	10.58
Hispanic	17.38	11.67
Other	8.24	7.70
Charlson co-morbidity index, mean ± SD	1.33 ± 1.98	3.11 ± 2.59	< 0.001
Hospital Frailty Risk Score, mean ± SD	1.71 ± 1.55	8.56 ± 3.14	< 0.001
In-hospital all-cause mortality, %	0.25	4.20	< 0.001
Length of Stay (Days), mean ± SD	4.37 ± 3.80	9.39 ± 10.32	< 0.001
Total Charges ($), mean ± SD	62,386.77 ± 50,903.26	118,875.9 ± 175,602	< 0.001
Post Procedure complications, %
Post-ERCP pancreatitis	3.44	7.38	< 0.001
Perforation	0.43	1.28	< 0.001
Bleeding	0.31	0.81	< 0.001
Peritonitis	0.29	1.25	< 0.001
Cardiac complications, %	5.50	22.19	< 0.001
Pulmonary complications, %	4.75	22.11	< 0.001
GI complications, %	19.82	25.95	< 0.001
ID complications, %	4.59	39.23	< 0.001
Anesthesia and drug-related complications, %	0.02	0.08	0.001
Required Intensive Care Unit, %	0.53	8.56	< 0.001
Multivariate Regression for the Outcomes^#
Outcome	Adjusted Odds Ratio (FrailERCP vs NonFrailERCP)	95% CI	p-value
In-hospital mortality	9.93	[7.38 – 13.35]	< 0.001
Length of Stay (Days)	4.53^&	[4.28 – 4.77]	< 0.001
Total Charges ($)	54,659.9$^&	[50,176.52$ – 59,143.28$]	< 0.001
Cardiac complications	2.29	[2.12 – 2.46]	< 0.001
Pulmonary complications	4.90	[4.52 – 5.31]	< 0.001
GI complications	1.68	[1.58 – 1.77]	< 0.001
ID complications	12.83	[11.85 – 13.88]	< 0.001
Anesthesia and drug-related complications	3.68	[2.13 – 15.13]	0.001
Required Intensive Care Unit	17.19	[13.99 – 21.13]	< 0.001

* Frail =Hospital Frailty Risk Score (HFRS)≥5

^# Analysis adjusted for age, gender, race, hospital location and teaching status, insurance, median household income and Charlosn co-morbidity index

^& Adjusted co-efficient representing the average difference in this outcome between FrailERCP and NonFrailERCP

Table: Baseline characteristics and outcomes of the frail and non-frail groups undergoing ERCP.

Disclosures:

Ahmad Nawaz indicated no relevant financial relationships.

Abdelkader Chaar indicated no relevant financial relationships.

Rabia Rizwan indicated no relevant financial relationships.

Dania Abdulkarim indicated no relevant financial relationships.

Fatima Khalid indicated no relevant financial relationships.

Thiruvengadam Muniraj indicated no relevant financial relationships.

Ahmad Nawaz, MD¹, Abdelkader Chaar, MD¹, Rabia Rizwan, MD¹, Dania Abdulkarim, MD², Fatima Khalid, ³, Thiruvengadam Muniraj, MD, PhD¹. B0459 - Impact of Frailty on ERCP Outcomes, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.