Rheumatoid Arthritis, Frailty, and Outcomes of Surgical Hospitalizations: A National Population-Based Analysis

Hospitalization, particularly for surgery, represents a period of heightened stress. We evaluated how frailty attenuates the association of rheumatoid arthritis (RA) with negative health outcomes after elective noncardiac surgery.

We conducted a cross-sectional study using the National Inpatient Sample (2018 to 2020), including adults (aged ≥18 years) with elective hospitalizations with noncardiac surgery. Frailty was measured using the Hospital Frailty Risk Score (HFRS). Surgeries were categorized by risk level. Outcomes included discharge health resources need (DHRN), composite adverse clinical events (CACE), and death.

Among 8,800,359 hospitalizations (2.14% among patients with RA), 73.36% underwent intermediate-risk surgery and 62.25% had HFRS above 0. DHRN occurred in 28.9%, CACE occurred in 0.93%, and all-cause mortality occurred in 0.17%. A 10-point increase in HFRS was associated with a 3.8-fold increased DHRN, 8.5-fold increased CACE, and 22.8-fold increased mortality. RA was not independently associated with CACE (adjusted odds ratio [aOR] 0.91; 95% confidence interval [CI] 0.82-1.01; P = 0.08) or death (aOR 0.90; 95% CI 0.71-1.15; P = 0.41) but was significantly associated with DHRN (aOR 1.28, 95% CI 1.25-1.31; P < 0.001) after adjusting for confounders and frailty. In sensitivity analysis, RA had 10% higher relative odds of DHRN following orthopedic (aOR 1.10; 95% CI 1.07-1.13; P < 0.001) but not nonorthopedic intermediate-risk surgery (aOR 1.10; 95% CI 0.98-1.23; P = 0.11).

RA was associated with higher odds of DHRN after orthopedic intermediate-risk surgery but not CACE or inpatient mortality. Moreover, HFRS was associated with DHRN, CACE, and death. These findings underscore the need for disease-specific clinical considerations and highlight the potential utility of HFRS in discharge planning.