Clinical frailty is a risk factor of adverse outcomes in patients with esophageal cancer undergoing esophagectomy: analysis of 2011-2017 US hospitals.

ABSTRACT

Frailty is an aggregate of medical and geriatric conditions that affect elderly and vulnerable patients; as frailty is known to affect postoperative outcomes, we evaluate the effects of frailty in patients undergoing esophageal resection surgery for esophageal cancer. 2011-2017 National Inpatient Sample was used to isolate younger (18 to <65) and older (65 or greater) patients undergoing esophagectomy for esophageal cancer, substratified using frailty (defined by Johns-Hopkins ACG frailty indicator) into frail patients and non-frail controls; the controls were 11 matched with frail patients using propensity score. Endpoints included mortality, length of stay (LOS), costs, discharge disposition, and postsurgical complications. Following the match, there were 363 and equal number controls in younger cohort; 383 and equal number controls in older cohort. For younger cohort, frail patients had higher mortality (odds ratio [OR] 3.14 95% confidence interval [CI] 1.39-7.09), LOS (20.5 vs. 13.6 days), costs ($320,074 vs. $190,235) and were likely to be discharged to skilled nursing facilities; however, there was no difference in postsurgical complications. In multivariate, frail patients had higher mortality (aOR 3.00 95%CI 1.29-6.99). In older cohort, frail patients had higher mortality (OR 1.96 95%CI 1.07-3.60), LOS (19.9 vs. 14.3 days), costs ($301,335 vs. $206,648) and were more likely to be discharged to short-term hospitals or skilled nursing facilities; the frail patients were more likely to suffer postsurgical respiratory failure (OR 2.03 95%CI 1.31-3.15). In multivariate, frail patients had higher mortality (aOR 1.93 95%CI 1.04-3.58). Clinical frailty adversely affects both younger and older patients undergoing esophagectomy for esophageal cancer.