Frailty as a Predictor of Outcomes in Patients With Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

We aimed to determine the association between frailty status and outcomes in patients with post-ERCP pancreatitis (PEP).

Appended data were obtained from the 2016-2017 National Inpatient Sample (NIS) database. We performed a nationwide cohort study utilizing International Classification of Diseases (ICD) diagnostic codes to identify adult patients with PEP. The Hospital Frailty Risk Score (HFRS) was used to classify patients as frail or non-frail. The primary outcome was composite complications related to PEP including all-cause mortality. Secondary outcomes were length of stay and total hospitalization costs.

There were 41,615 patients represented in the data, with 34.6% (14,382) characterized as frail and 65.4% (27,233) as non-frail. Of frail patients, 60.7% suffered composite complications related to PEP compared with 29.3% of non-frail patients ( P < 0.001). Frail patients had more cardiovascular, pulmonary, gastrointestinal, renal and endocrine, neurological, and infectious complications compared with non-frail patients. Frail patients also had higher all-cause mortality rates during inpatient admission (4.6% vs under 0.1%, P < 0.001) and increased length of stay (11.6 vs 0.8 d, P < 0.001) as well as total hospitalization charges ($140,855 vs $73,539, P < 0.001). On multivariable analysis, positive frailty status was associated with 2.94 times increased odds of having composite complications.

Frailty assessments can be utilized as a predictor of outcomes and serve to guide clinical decision-making when determining prophylactic measures in patients undergoing ERCP who may be at risk for PEP.