Frailty, Comorbidities, and In-Hospital Outcomes in Older Cholangiocarcinoma Patients

Introduction: Frailty is increasingly recognized as a critical predictor of adverse outcomes in older adults, particularly those with cancer. However, the role of frailty-distinct from comorbidity burden-has not been fully characterized in older adults hospitalized with cholangiocarcinoma (CCA), a rare but aggressive malignancy with rising incidence in the aging population. Methodology: A retrospective cross-sectional analysis of the Nationwide Inpatient Sample (NIS) 2019-2022 was performed. Adult inpatients aged ≥ 65 with CCA-related ICD-10 codes were identified. Patients were stratified into frailty categories based on the Hospital Frailty Risk Score (HFRS). Multivariable regression models were used to assess associations with in-hospital mortality, length of stay (LOS), and hospital charges. Results: Among 18,785 hospitalizations, the in-hospital mortality rate was 7.18%. High frailty conferred an eight-fold increased risk of mortality, a 70% longer LOS, and 52% higher charges compared to low frailty. Elixhauser comorbidity scores were not significantly associated with outcomes. Discussion: These findings support the use of frailty screening to guide inpatient care planning and optimize outcomes in older adults with CCA.