Impact of Frailty on Per Oral Endoscopic Myotomy (POEM) Outcomes: A National Database Analysis

Introduction Frailty remains an important risk factor for increased morbidity and mortality in patients undergoing various surgical interventions. The impact of frailty on clinical outcomes in patients undergoing Peroral Endoscopic Myotomy (POEM) is not well established. We aim to determine the association between frailty and clinical outcomes in patients hospitalized for POEM procedure. Methods We conducted a cohort study using data from the National Inpatient Sample (NIS) for the years 2017 to 2019. Adult patients who underwent POEM following hospitalization were identified using International Classification of Diseases (ICD) diagnostic codes. The Hospital Frailty Risk Score (HFRS) was used to classify patients as Frail or Non-Frail. Multivariate logistic regression analysis was performed to compare outcomes between study groups. Discharge weights were applied to provide national estimates for total hospital expenses. Results Among 1,735 POEM patients, 220 (12.68%) patients were frail. Frail patients had higher Charlson Comorbidity Index (CCI) compared to non-frail patients. In terms of systemic adverse events, frail patients had more cardiovascular (2.27% vs 0.00%, p < .01), thoracic (13.64% vs 2.97%, p < .01), and infectious (18.18% vs 2.64%, p < 0.01) adverse events compared to non-frail patients. The number of patients requiring TPN was higher in frail (13.64 vs 1.32, p < 0.01) compared to non-fail patients. After adjusting for confounders, frail patients were more likely to require TPN [OR 13.49 (95% CI 2.00-91.25)], had higher incidence of infectious [OR 17.38 (95% CI 5.22–57.91)] and thoracic [OR 5.75 (95% CI 1.75–18.92)] adverse events as well as increased LOS [OR 6.56 (95% CI 3.64–9.47)] when compared to non-frail patients. Conclusion Frailty in patients undergoing POEM is associated with a higher risk of systemic adverse events, need for TPN, longer hospital stays, higher healthcare cost, and increased in-hospital mortality. These findings emphasize the importance of frailty assessments in clinical decision-making for patients undergoing POEM.