Frailty Is Independently Associated with Higher Mortality and Readmissions in Patients with Acute Biliary Pancreatitis: A Nationwide Inpatient Study

Background: Acute pancreatitis is the most common gastrointestinal cause of hospital admissions in the United States of which biliary or gallstone disease is the most common inciting factor.

Aim: Estimate the effects of frailty on burden, costs, and causes for hospitalization in patients with acute biliary pancreatitis.

Methods: We analysed the Nationwide Readmission Database from 2016 to 2019 for patients with acute biliary pancreatitis. Patients were categorized into two groups, frail and non-frail, based on the Hospital Frailty Risk Score. Logistic and Cox regression were used to predict the impact of frailty on 30-day readmission, length of stay, mortality, and costs.

Results: 162,202 index hospitalizations with acute biliary pancreatitis without cholangitis were identified, of whom 59.2% (n = 96,045) were female and 22.49% (n = 36,475) were classified as frail. Readmissions within 30 days were higher among frail patients (12.58% vs 7.09%, P < 0.001) compared to non-frail patients, respectively. Regression modeling showed that frail patients had higher odds of readmission (OR 1.32; 95% CI 1.24-1.42, P < 0.001), longer lengths of stay (8.18 days vs 4.11 days), and higher average costs of hospitalization ($21,511 vs $12,261) compared to non-frail patients, respectively. Cox regression showed that frail patients had a higher risk of mortality (HR 5.43; 95% Cl 4.06-7.29, P < 0.001) compared to non-frail patients, respectively.

Conclusions: Frailty is independently associated with higher mortality and burden of healthcare utilization in patients with acute biliary pancreatitis. We suggest using the Hospital Frailty Risk Score as part of the treatment algorithm in patients with acute biliary pancreatitis.