Introduction

To understand the effects of frailty on hospital outcomes such as in-hospital mortality, length of stay, and healthcare cost among patients with cancer using a nationally representative database.

Materials and Methods

This study was a retrospective observational analysis of Nationwide Inpatient Sample (NIS) data collected during 2005–2014. Participants included adult patients with cancer ≥45 years identified by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. ‘Frail’ versus ‘non-frail’ hospitalizations were determined using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnosis indicator. Main outcome measures were in-hospital mortality, hospital length of stay, and hospitalization cost. We defined prolonged length of stay as hospital stay ≥75th percentile of the study sample. Propensity score match analysis was done to examine whether frailty was associated with length of stay and in-hospital mortality.

Results

There were 10,463,083 cancer hospitalizations during 2005–2014, of which 1,022,777 (9.8%) were frail. Patients having length of stay ≥8 days were significantly higher among frail group, compared to non-frail group (53.3% versus 25.3%, P < 0.001). Similarly, unadjusted mortality (12.0% versus 5.3%, P < 0.001) and hospitalization costs ($29,726 versus $18,595, P < 0.001) were significantly higher for frail patients. Nearly $28 billion was expended on hospitalization of frail patients with cancer during the study period. In propensity score match analysis, the odds of in-hospital mortality (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.50–1.58) and length of stay (OR, 2.23; 95% CI, 2.18–2.27) were significantly greater for frail patients.

Discussion

Frailty was associated with adverse hospital outcomes such as increased length of stay, mortality, and hospitalization cost among all cancer types. Our findings could be valuable for frailty-based risk stratification of patients with cancer. Concerted efforts by the physiatrists, oncologists, and surgeons towards identifying frailty and incorporating it in risk estimation measures could help in optimizing management strategies for cancer.

中文翻译：

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美国癌症患者身体虚弱对住院结局的影响：来自全国住院患者样本的结果

介绍

使用具有全国代表性的数据库了解身体虚弱对癌症患者住院死亡率、住院时间和医疗费用等医院结局的影响。

材料和方法

本研究是对 2005-2014 年间收集的全国住院患者样本 (NIS) 数据的回顾性观察分析。参与者包括由国际疾病分类第九修订版临床修订 (ICD-9-CM) 代码确定的 ≥45 岁的成年癌症患者。使用约翰霍普金斯调整临床组 (ACG) 虚弱定义诊断指标确定“虚弱”与“非虚弱”住院治疗。主要结局指标是住院死亡率、住院时间和住院费用。我们将住院时间延长定义为住院时间≥研究样本的第 75 个百分位。进行倾向得分匹配分析以检查虚弱是否与住院时间和住院死亡率相关。

结果

2005-2014 年间有 10,463,083 人因癌症住院，其中 1,022,777 人（9.8%）身体虚弱。体弱组住院时间≥8天的患者明显高于非体弱组（53.3% vs 25.3%，P < 0.001）。同样，体弱患者的未调整死亡率（12.0% 对 5.3%，P < 0.001）和住院费用（29,726 美元对 18,595 美元，P < 0.001）明显更高。在研究期间，将近 280 亿美元用于治疗体弱的癌症患者。在倾向得分匹配分析中，住院死亡率（优势比 [OR]，1.54；95% 置信区间 [CI]，1.50-1.58）和住院时间（OR，2.23；95% CI，2.18-2.27）的几率) 对于体弱的患者显着更大。

讨论

在所有癌症类型中，虚弱与不良住院结局相关，例如住院时间、死亡率和住院费用增加。我们的研究结果可能对癌症患者基于虚弱的风险分层很有价值。理疗师、肿瘤学家和外科医生共同努力识别虚弱并将其纳入风险评估措施，有助于优化癌症管理策略。