The Impact of Frailty on Short-Term Outcomes After Surgery for Zenker Diverticulum

Determine relationship between frailty and hospital mortality, length of stay, cost, and medical and surgical complications in Zenker diverticulum surgery.

Retrospective cross-sectional.

National database.

Data from the National Inpatient Sample for 712 patients who underwent surgery for Zenker diverticulum 2016 to 2021 were analyzed using multivariate regressions. Frailty was defined as at least 1 frailty-defining diagnosis from the Johns Hopkins ACG® Frailty Indicator. Elixhauser Comorbidity Index was calculated to quantify comorbidity burden.

12.2% of patients were identified as frail, 77.0% of whom had a weight loss or malnutrition diagnosis. Frailty predicted increased length of stay (mean, 4.09 days [95% CI: 2.98-5.20]) and increased costs (mean, $10,500.36 [95% CI: $6885.76-$14,114.95]). Frail patients were more likely to have medical complications compared to non-frail patients (OR = 2.84 [95% CI: 1.66-4.84]). Elixhauser Comorbidity Index was predictive of hospital mortality (OR = 1.78 [95% CI: 1.27-2.51]) and likelihood of endoscopic surgical complications (OR = 1.25 [95% CI: 1.05-1.47]), but frailty was not predictive of either.

Frailty is not associated with increased risk of surgical complications or mortality and is not an absolute contraindication to Zenker diverticulum surgery. Frailty predicts length of stay, costs, and medical complications in Zenker diverticulum surgery and should be used with comorbidity to stratify patient risk for surgery. Prospective studies involving frail patients could help develop a standardized method for assessing surgical fitness, potentially expanding treatment options and improving outcomes for this population.