Association of Frailty and Postoperative Outcomes across Race and Ethnicity

Frailty and race/ethnicity, respectively, have been shown to be significantly associated with adverse postoperative outcomes. However, little is known about whether frailty's association with surgical outcomes differs across racial/ethnic groups. This study aimed to examine whether frailty's association with in-hospital mortality and non-home discharge differed across race/ethnicity after in-patient surgery.

We performed a retrospective cohort study using the National Inpatient Sample from 2016 to 2018. Adults aged 65 years and older undergoing major inpatient surgery were included. Frailty was assessed using the Hospital Frailty Risk Score (HFRS) and classified as frail (≥ 5) or non-frail (< 5). The primary outcome was in-hospital mortality, and the secondary outcome was non-home discharge. After adjusting for covariates, multivariable logistic regression was used to evaluate associations between frailty, race/ethnicity, and primary and secondary outcomes.

1,716,390 encounters were included in our cohort, and 35.0% were classified as frail. Frailty was strongly associated with increased mortality (OR 5.66, 95% CI: 5.40-5.92, p-value < 0.001) and non-home discharge (OR 3.14, 95% CI: 3.10-3.18, p-value < 0.001). Black (42.9%), Hispanic (37.8%), and Asian (37.8%) patients were more frequently categorized as frail compared to White patients (34.0%). Interaction analyses demonstrated that the magnitude of frailty's association with mortality was weaker among Black patients (OR 0.87, 95% CI: 0.78-0.99), and frailty's association with non-home discharge was reduced across all non-White groups. Sensitivity analyses showed consistent findings across surgical subspecialties.

The strength of frailty's association with in-hospital mortality and non-home discharge varied across racial/ethnic groups. These findings raise concerns about the validity of frailty assessment tools and highlight the need for validation of these tools in in diverse surgical populations to ensure equitable perioperative risk stratification.