Frailty as a Predictor of Outcomes in Patients with Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

BACKGROUND The development of acute pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography (ERCP). AIMS We aimed to determine the association between frailty status and outcomes in patients with post-ERCP pancreatitis (PEP). METHODS We performed a cohort study using merged data from the 2016 and 2017 National Inpatient Sample (NIS) database. International Classification of Diseases (ICD), Tenth Revision, Clinical Modification (ICD-10-CM) and Procedure Coding system (ICD-10-PCS) diagnostic codes were utilized to identify adult patients with PEP. Using a validated frailty definition based on ICD codes known as the Hospital Frailty Risk Score (HFRS), we then classified patients as frail versus non-frail in this selected population. Primary outcomes were pancreatitis-related and peri-procedural complications including all-cause mortality. Secondary outcomes were length of stay and total hospitalization costs. 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 PEP complications. RESULTS There were 41,615 patients represented in the data, with 34.6% (14,382) characterized as frail and 65.4% (27,233) as non-frail. 60.7% of frail patients suffered composite complications related to PEP compared to 29.3% of non-frail patients (P < 0.001). Frail patients had more cardiovascular, pulmonary, gastrointestinal, renal and endocrine, neurologic, and infectious complications compared to non- frail patients. Frail patients also had higher all-cause mortality rates during inpatient admission (4.6% vs under 0.1%, P < 0.001) and increased length of stay (11.6 days vs 0.8, P < 0.001) as well total hospitalization charges ($140,855 vs $73,539, P < 0.001). On multivariable analysis, positive frailty status was associated with 2.94 times increased odds of having composite complications. CONCLUSION In hospitalized patients with post-ERCP pancreatitis, frailty status is associated with increased complications including all-cause mortality during hospitalization. Frail patients with PEP also have increased length of stay and total hospitalization costs during admission. Frailty assessments can thus be utilized as a predictor of outcomes and serve to guide clinical decision-making when determining prophylactic measures in patients undergoing ERCP who may be at risk for PEP.