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Frailty Is Independently Associated with Higher Mortality and Readmissions in Patients with Acute Biliary Pancreatitis: A Nationwide Inpatient Study

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Abstract

Background

Acute pancreatitis is the most common gastrointestinal cause of hospital admissions in the United States of which biliary or gallstone disease is the most common inciting factor.

Aim

Estimate the effects of frailty on burden, costs, and causes for hospitalization in patients with acute biliary pancreatitis.

Methods

We analysed the Nationwide Readmission Database from 2016 to 2019 for patients with acute biliary pancreatitis. Patients were categorized into two groups, frail and non-frail, based on the Hospital Frailty Risk Score. Logistic and Cox regression were used to predict the impact of frailty on 30-day readmission, length of stay, mortality, and costs.

Results

162,202 index hospitalizations with acute biliary pancreatitis without cholangitis were identified, of whom 59.2% (n = 96,045) were female and 22.49% (n = 36,475) were classified as frail. Readmissions within 30 days were higher among frail patients (12.58% vs 7.09%, P < 0.001) compared to non-frail patients, respectively. Regression modeling showed that frail patients had higher odds of readmission (OR 1.32; 95% CI 1.24–1.42, P < 0.001), longer lengths of stay (8.18 days vs 4.11 days), and higher average costs of hospitalization ($21,511 vs $12,261) compared to non-frail patients, respectively. Cox regression showed that frail patients had a higher risk of mortality (HR 5.43; 95% Cl 4.06–7.29, P < 0.001) compared to non-frail patients, respectively.

Conclusions

Frailty is independently associated with higher mortality and burden of healthcare utilization in patients with acute biliary pancreatitis. We suggest using the Hospital Frailty Risk Score as part of the treatment algorithm in patients with acute biliary pancreatitis.

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Authors and Affiliations

  1. Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, UT, USA

    Daryl Ramai & John Morris

  2. Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ, USA

    Joseph Heaton

  3. Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA

    Ahmed Abomhya

  4. Center for Advanced Therapeutic Endoscopy (CATE), Porter Adventist Hospital/PEAK Gastroenterology, Denver, CO, USA

    Douglas G. Adler

Authors
  1. Daryl Ramai
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  2. Joseph Heaton
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  3. Ahmed Abomhya
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  4. John Morris
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Contributions

DR conceived and designed the study. JH, AA collected data. DR and JH conducted data analysis. DR drafted the manuscript. JM and DGA revised the manuscript for intellectual content. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Douglas G. Adler.

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Conflict of interest

Dr. Douglas G. Adler is a consultant for Boston Scientific and Micro Tech. All other authors have no relevant conflict of interests.

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Ramai, D., Heaton, J., Abomhya, A. et al. Frailty Is Independently Associated with Higher Mortality and Readmissions in Patients with Acute Biliary Pancreatitis: A Nationwide Inpatient Study. Dig Dis Sci 68, 2196–2203 (2023). https://doi.org/10.1007/s10620-023-07830-7

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  • DOI: https://doi.org/10.1007/s10620-023-07830-7

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