E0024 - The Impact of Frailty on Outcomes Among Hospitalized Patients With Chronic Pancreatitis

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

VK

Vivek Kumar, MD

Brigham and Women's Hospital
Boston, Massachusetts

Vivek Kumar, MD, Ebrahim Barkoudah, MD, MPH, David X Jin, MD, MPH, Julia Y. McNabb-Baltar, MD, MPH, Peter A Banks, MD
Brigham and Women's Hospital, Boston, MA

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 1^st, 2019, to June 30^th, 2019. These patients were followed till Dec 31^st, 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.

Figure: Fig 1. Kaplan-Meier curve showing (a) 6-month mortality (b) 6-month readmission among chronic pancreatitis patients stratified by frailty

Outcome	Frail (%, 95%CI)	non-Frail (%, 95%CI)	*p-value*
Primary Outcomes
Readmission rates at 6 months	51.06(50.15-52.12)	45(44.32-45.92)	< 0.001
Mortality at 6 months	5.24(5.13-5.69)	0.68(0.56-0.81)	< 0.001
Hospitalization characteristics
Unplanned Hospitalizations	96.1(95.7-96.5)	92(91.2-92.7)	< 0.001
Preventable Hospitalizations	12.72(12.21-13.24)	7.6(7.21-8)	< 0.001
Severe hospitalizations (Grade 3 and 4)	62.45(61.56-63.32)	24.1(23.5-24.8)	< 0.001
Severe AP related hospitalizations	5.67(5.37-5.99)	3.99(3.75-4.25)	< 0.001
Chronic Pancreatitis related procedures	3.59(3.19-4.04)	8.8(8.1-9.54)	< 0.001
Causes of readmission
Acute pancreatitis	13.43	32.3	< 0.001
Infectious causes	16.68	7.38	< 0.001
Gastrointestinal (except pancreatitis)	14.01	15.25	< 0.001

Table: Table 1. Primary outcomes, hospitalization characteristics, and causes of readmissions among non-frail and frail patients with chronic pancreatitis.

Disclosures:

Vivek Kumar indicated no relevant financial relationships.

Ebrahim Barkoudah: Alexion – travel grant. Bristol Myers Squibb – Advisory Committee/Board Member, Grant/Research Support. Janssen – Advisory Committee/Board Member, Grant/Research Support. Novartis – Grant/Research Support. Pfizer – Advisory Committee/Board Member. Portola – Advisory Committee/Board Member.

David X Jin indicated no relevant financial relationships.

Julia McNabb-Baltar indicated no relevant financial relationships.

Peter A Banks indicated no relevant financial relationships.

Vivek Kumar, MD, Ebrahim Barkoudah, MD, MPH, David X Jin, MD, MPH, Julia Y. McNabb-Baltar, MD, MPH, Peter A Banks, MD. E0024 - The Impact of Frailty on Outcomes Among Hospitalized Patients With Chronic Pancreatitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.