Camilo J. Acosta, MD, Sunil Amin, MD, David Goldberg, MD; University of Miami, Jackson Memorial Hospital, Miami, FL
Introduction: Frailty is a known predictor of mortality and complications in the inpatient setting; however, it has not been studied as a modality to assess risk among patients undergoing endoscopy for GI bleeding. We aimed to determine the association between frailty status and complication risk in hospitalized patients with GI bleeding who underwent endoscopy. Methods: We performed a cohort study using the 2016 and 2017 NIS database. ICD 10th Revision, Clinical Modification (ICD-10-CM) and Procedure Coding System (ICD-10-PCS) diagnostic codes were utilized to identify adult patients with Upper GI or Lower GI bleeding who underwent endoscopic procedures (upper endoscopy and/or colonoscopy). Using a validated frailty definition based on ICD codes known as the Hospital Frailty Risk Score (HFRS), we then identified patients who were frail versus non-frail in this selected population. Our primary outcome was peri-procedural complications. We constructed multivariable logistic regression models, adjusting for clinically pertinent confounders (i.e. age, sex, comorbidities using the Charlson comorbidity index) to determine the association between frailty and peri-procedural complications. Results: There were 1,027,650 patients represented in the data, with 49.7% (510,965) identified as frail and 50.3% (516,690) as non-frail. 55.7% of frail patients suffered composite peri-procedural complications compared to 28.1% of non-frail patients (P < 0.001). Frail patients had more cardiovascular (35.6% vs 18.9%, P < 0.001), pulmonary (23.3% vs 5.1%, P < 0.001), gastrointestinal (11.8% vs 7.1%, P < 0.001), infectious (14.8% vs 1.0%, P < 0.001), and neurologic (1.9% vs 1.0%, P < 0.001) complications compared to non-frail patients. Frail patients also had higher all-cause mortality rates during inpatient admission (4.8% vs 0.5%, P < 0.001). On multivariable analysis, positive frailty status was associated with a 2.44 times increased likelihood of having composite peri-procedural complications. Marginal standardization analysis between age and frailty showed a consistent absolute increase in complications for frail patients irrespective of increasing age. Discussion: In hospitalized patients undergoing endoscopy for GI bleeding, frailty status is associated with increased peri-procedural complications including all-cause mortality during hospitalization. The use of frailty assessments can thus further guide clinical decision-making when considering endoscopy and complication risk in adult patients with GI hemorrhage.
Demographic characteristics of adult patients with GI bleeding who underwent endoscopy
Difference in Periprocedural Complications between Frail and Non-frail patients with GI bleeding who underwent Endoscopy
Multivariable Analysis for Predictors of Composite Complications in Patients with GI Bleeding
Disclosures: Camilo Acosta indicated no relevant financial relationships. Sunil Amin indicated no relevant financial relationships. David Goldberg indicated no relevant financial relationships.