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The hospital frailty risk score as a predictor of readmission after ERCP

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Abstract

Background and aims

The 30-day readmission rate is a nationally recognized quality measure with nearly one-fifth of patients being readmitted. This study aims to evaluate frailty, as measured by the hospital frailty risk score (HFRS), as a prognostic indicator for 30-day readmission after inpatient ERCP.

Methods

We analyzed weighted discharge records from the 2017 Nationwide Readmissions Database (NRD) to identify patients undergoing ERCP between 01/01/2017 and 11/30/2017. Our primary outcome was the 30-day unplanned readmission rate in frail (defined as HFRS > 5) against non-frail (HFRS < 5) patients. A mixed effects multivariable logistic regression method was employed.

Results

Among 68,206 weighted hospitalized patients undergoing ERCP, 31.3% were frail. Frailty was associated with higher 30-day readmission (OR 1.23, 95% CI [1.16–1.30]). Multivariable analysis showed a greater risk of readmission with cirrhosis (OR 1.26, 95% CI [1.10–1.45]), liver transplantation (OR 1.36, 95% CI [1.08–1.71]), cancer (OR 1.58, 95% CI [1.48–1.69]), and male gender (OR 1.24, 95% CI [1.18–1.31]). Frail patients also had higher mortality rate (1.8% vs 0.6%, p < 0.01)], longer LOS during readmission (6.7 vs 5.6 days, p < 0.01), and incurred more charges from both hospitalizations ($175,620 vs $132,519, p < 0.01). Sepsis was the most common primary indication for both frail and non-frail readmissions but accounted for a greater percentage of frail readmissions (17.9% vs 12.4%, p < 0.01).

Conclusions

Frailty is associated with higher readmission rates, mortality, LOS, and hospital charges for admitted patients undergoing ERCP. Sepsis is the leading cause for readmission. Independent risk factors for readmission include liver transplantation, cancer, cirrhosis, and male gender.

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Abbreviations

ASGE:

American Society of Gastrointestinal Endoscopy

AHRQ:

Agency for Healthcare Research and Quality

CCI:

Charlson Comorbidity Index

CI:

Confidence interval

CMS:

Centers for Medicare & Medicaid Services

ERCP:

Endoscopic retrograde cholangiopancreatography

GI:

Gastroenterology

HFRS:

Hospital frailty risk score

HCUP:

Healthcare cost and utilization project

ICD-10:

International statistical classification of diseases and related health problems version 10

OR:

Odds ratio

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, University of California San Diego Medical Center, La Jolla, CA, 92103, USA

    Khanh Hoang Nicholas Le, Alexander S. Qian, Mimi Nguyen, Edmund Qiao, Siddharth Singh & Mary Lee Krinsky

  2. Hoag Memorial Hospital Presbyterian, Newport Beach, CA, 92663, USA

    Phuong Nguyen

Authors
  1. Khanh Hoang Nicholas Le
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  2. Alexander S. Qian
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  3. Mimi Nguyen
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  4. Edmund Qiao
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  7. Mary Lee Krinsky
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Correspondence to Mary Lee Krinsky.

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Khanh Hoang Nicholas Le, Alexander S. Qian, Mimi Nguyen, Edmund Qiao, Phuong Nguyen, Siddharth Singh, and Mary Lee Krinsky have no conflicts of interest or financial ties to disclose.

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Le, K.H.N., Qian, A.S., Nguyen, M. et al. The hospital frailty risk score as a predictor of readmission after ERCP. Surg Endosc 38, 260–269 (2024). https://doi.org/10.1007/s00464-023-10531-x

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  • DOI: https://doi.org/10.1007/s00464-023-10531-x

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