Relationship Between Frailty and Hospital Outcomes Among Cancer Patients in The United States

Research Objectives: To understand the effects of frailty on hospital outcomes such as in-hospital mortality, length of stay, and healthcare cost among cancer patients using a nationally representative database.

Design: This was a retrospective observational analysis.

Setting: Nationwide Inpatient Sample (NIS) data collected during 2005-2014.

Participants: Cancer patients ≥45 years of age.

Interventions: Not applicable

Main Outcome Measures: In-hospital mortality, hospital length of stay, and hospitalization cost. Propensity score match analysis was done to examine whether frailty was associated with length of stay and in-hospital mortality.

Results: There were 10,463,083 cancer hospitalizations during 2005-2014, of which 1,022,777 (9.8%) were frail. Patients having length of stay ≥8 days were significantly higher among frail group, compared to non-frail group (53.3% versus 25.3%, P < 0.001). Similarly, unadjusted mortality (12.0% versus 5.3%, P < 0.001) and hospitalization costs ($29,726 versus $18,595, P< 0.001) were significantly higher for frail patients. Nearly $28 billion was expended on hospitalization of frail cancer patients during the study period. In propensity score match analysis, the odds of in-hospital mortality (OR, 1.54; 95% CI, 1.50-1.58) and length of stay (OR, 2.23; 95% CI, 2.18-2.27) were significantly greater for frail patients.

Conclusions: Frailty was associated with adverse hospital outcome such as increased length of stay, mortality, and hospitalization cost among all cancer types. Our findings could be valuable for frailty-based risk stratification of cancer patients. Concerted efforts by the physiatrists, oncologists, and surgeons towards identifying frailty and incorporating it in risk estimation measures could help in optimizing management strategies for cancers.

Author(s) Disclosures: The authors report no real or perceived vested interests that relate to this article that could be construed as a conflict of interest.