Background The relationship between frailty and healthcare resource utilization in older patients with colorectal cancer (CRC) remains insufficiently quantified. We evaluated the associations of frailty with high inpatient costs, length of stay (LOS), and adverse events, and examined the explanatory roles of co-occurring comorbidity burden and postoperative complications. Methods This multicenter retrospective study analyzed 4,936 patients aged ≥60 years undergoing elective CRC surgery between 2014 and 2024. Hierarchical multivariable regression models evaluated associations between frailty and outcomes. Mediation-style decomposition was used to estimate the extent to which comorbidity burden and postoperative complications explained frailty-associated differences in high inpatient costs and LOS. A simulation-based sensitivity analysis was performed to assess the potential impact of ICD-10-based frailty misclassification. A Bonferroni-corrected threshold of p < 0.006 was applied. Results Frailty was significantly associated with high inpatient costs (OR = 1.274, 95% CI: 1.083–1.498, p = 0.003), prolonged LOS (log-transformed β = 0.082, 95% CI: 0.053–0.111, p < 0.001), and adverse events (OR = 3.317, 95% CI: 2.267–4.854, p < 0.001). Mediation-style decomposition showed that co-occurring comorbidity burden explained 28.6% of frailty-associated difference in high inpatient costs (p < 0.001). Postoperative complications did not significantly explain the frailty–LOS association (3.8%, p = 0.368). The estimated excess socioeconomic burden associated with frailty was CNY 657 million. In the sensitivity analysis, the direction of frailty associations with all three outcomes remained unchanged across simulated ICD-10 misclassification scenarios, although the association with high inpatient costs was attenuated under moderate and severe assumptions. Conclusion Frailty was associated with increased healthcare resource utilization and adverse outcomes in older CRC patients. Co-occurring comorbidity burden partly explained the frailty-associated difference in high inpatient costs, whereas prolonged LOS was not significantly explained by postoperative complications. These findings support routine frailty screening and dual-track perioperative optimization targeting both comorbidity burden and frailty-related physiological vulnerability.
Financial toxicity (FT) is increasingly recognized as a critical challenge in cancer care. Older patients can be particularly vulnerable due to frailty-related impairments and accumulated treatment burden. This study aimed to evaluate FT and its association with geriatric vulnerability among older patients with cancer. We conducted a single-center cross-sectional study of patients aged ≥ 65 years with cancer treated at a regional hospital in Japan. FT was assessed using the Comprehensive Score for Financial Toxicity (COST) instrument. Frailty-related vulnerability was evaluated using questionnaire-based assessments, including the G8 screening tool. Associations between the COST score and clinical variables were examined using univariate and multivariable linear regression analyses. Supplementary analyses were performed using the conventional G8 cutoff value (≤ 14). Ninety-one patients aged ≥ 65 years were included. The median COST score was 25 (range, 8–44). Lower G8 scores were significantly associated with greater FT (Pearson’s r = 0.345, p = 0.001). In the multivariable analysis, lower G8 scores (p = 0.048), poorer health-related quality of life (p = 0.036), and the receipt of multimodal therapy (p = 0.013) were independently associated with greater FT. Similar findings were observed when the G8 score was analyzed using the conventional cutoff value. Among older patients with cancer, FT was independently associated with geriatric vulnerability assessed by the G8 screening tool, in addition to health-related quality of life and treatment burden. The assessment of geriatric vulnerability may complement conventional socioeconomic indicators in identifying patients at an increased risk of FT.
Momoko Kobayashi, Jun Miyazaki, Yutaka Sugawara et al.· Supportive Care in Cancer· 0 citations
BackgroundTotal Knee arthroplasty (TKA) is an effective treatment for end-stage knee osteoarthritis (KOA), but healthcare resource utilization has become an increasing concern in an aging surgical population. Hospital Frailty Risk Score (HFRS) has been associated with adverse surgical outcomes, but its impact on resource utilization after TKA remains unclear. Using a large national database, this study aims to evaluate the association between HFRS-defined frailty risk categories and healthcare resource utilization after TKA, including length of stay (LOS), total charges (TOTCHG), and non-routine discharge.MethodsData on patients undergoing TKA were extracted from the National Inpatient Sample database. Patients were categorized into an analytic cohort and a validation cohort. We used the HFRS to identify frailty: low frailty risk (HFRS < 5), intermediate frailty risk (5-15), and high frailty risk (HFRS > 15). Patient demographic, hospital characteristics, and comorbidities were assessed. Logistic regression analyses, stratified analyses, ROC curve analyses, and sensitivity analyses were performed to evaluate associations, subgroup consistency, and discriminative performance.ResultsA total of 622,574 patients undergoing TKA for primary KOA were identified. Patients were categorized into low (n = 439,343), intermediate (n = 29,637), and high (n = 223) frailty risk groups according to the HFRS. In multivariable logistic regression analyses, higher HFRS-defined frailty risk categories were independently associated with increased healthcare resource utilization and complications. Compared with patients with low frailty risk, those with intermediate and high frailty risk had significantly higher odds of prolonged LOS, increased TOTCHG, non-routine discharge, any complication, and major complications (all P < 0.001). Sensitivity analyses using a binary classification of HFRS-defined frailty yielded consistent findings.ConclusionHFRS-defined frailty risk categories are independently associated with increased healthcare resource utilization and postoperative complications after TKA. These findings support the potential utility of HFRS for preoperative risk stratification and individualized perioperative care planning.
Linjia Li, Zhihan Wang, Yuan. Wu et al.· Journal of Orthopaedic Surge...· 0 citations
Background The incidence of prolonged length of stay in the post-anesthesia care unit (PACU) is high among elderly patients undergoing painless gastrointestinal endoscopy, and the value of frailty assessment for perioperative risk stratification in this population remains unclear. Methods A total of 500 elderly patients undergoing outpatient painless gastrointestinal endoscopy were enrolled. Preoperative frailty was assessed using the Fried Frailty Phenotype, and perioperative clinical data were collected. Independent risk factors for prolonged PACU length of stay were identified through Logistic regression analysis, and a predictive model was constructed. Results Frailty severity showed a dose-dependent relationship with the incidence of intraoperative and postoperative adverse events and PACU length of stay. Multivariable analysis revealed that frailty was the strongest independent risk factor for prolonged PACU length of stay (OR = 4.278, 95%CI: 2.207-8.286, P < 0.001). The constructed multivariable predictive model had an area under the curve of 0.804, with a sensitivity of 82.4% and a specificity of 77.1%. Conclusions Frailty significantly increases the risk of prolonged PACU length of stay in elderly patients undergoing painless gastrointestinal endoscopy. The predictive model based on frailty status has favorable clinical application value.
Zhilin Chen, Jinguang Zhang, Wu-Dong Zhuang et al.· Frontiers in Medicine· 0 citations
AIM
Frailty is increasingly recognised as an age-independent predictor of adverse outcomes in cardiovascular disease, yet it is rarely assessed in acute coronary syndrome (ACS) due to practical limitations. This study examined the prognostic significance of frailty, assessed using a laboratory-based frailty index (FI-Lab), in patients with ACS undergoing percutaneous coronary intervention (PCI).
METHODS AND RESULTS
We conducted a multicentre retrospective cohort study across five Korean hospitals using the Observational Medical Outcomes Partnership Common Data Model. Adult patients (≥18 years) who underwent PCI for ACS were included. Frailty status was determined as FI-Lab ≥ 0.4, calculated as the proportion of deficits across 28 routine laboratory variables, with inclusion restricted to patients having at least 70% of laboratory values available. Propensity score matching (1:1) and cox proportional hazards regression were employed to examine the relationships between frailty and clinical outcomes including recurrent acute myocardial infarction, hospital readmissions, and all-cause mortality. Of 5,405 patients, 25.2% were classified as frail. After matching, 929 pairs were analysed. Frailty was significantly associated with hospital readmission (HR 1.946; 95% CI 1.635-2.316) and all-cause mortality (HR 3.675; 95% CI 2.680-5.038), but not with recurrent AMI (HR 0.995; 95% CI 0.854-1.160). Subgroup analyses confirmed consistent associations across age and sex, with robust links to mortality in patients ≥65 years.
CONCLUSION
Frailty, as assessed by FI-Lab, independently predicted hospital readmission and mortality after PCI in patients with ACS. Automated, laboratory-based frailty screening is feasible in acute settings and supports its integration into cardiovascular nursing for early risk stratification and personalised care.
Sujin Gan, E. Seo, Sang Youl Rhee et al.· European Journal of Cardiova...· 0 citations
Frailty is characterized by decreased physiological reserves and impaired functioning of multiple systems. This study investigated the association between frailty and hospital outcomes such as postoperative complications, length of hospital stays, readmission rates, and functional outcomes following THA.
Data for this study were retrieved from the Nationwide Inpatient Sample (NIS) database, 2018–2021. Adult patients 18 years and above with a primary diagnosis of THA were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-10-CM) codes. We identified frail patients using the Hospital Frailty Risk Score (HFRS). The main outcomes of this study were surgical complications, medical complications, in-hospital mortality, and prolonged length of stay.
There were 1,725,550 THA hospitalizations, of which 9.1% (156,275) were frail. Logistic regression analysis showed that frailty was associated with significantly greater odds of surgical complications (OR, 4.77, 95% CI: 4.27–5.33), medical complications (OR, 2.68, 95% CI: 2.59–2.76), other complications (OR, 8.13, 95% CI: 7.53–8.78), any complications (OR, 3.17, 95% CI: 3.08–3.27), mortality (OR, 2.74, 95% CI: 1.99–3.54), and prolonged length of stay (OR, 5.25, 95% CI: 5.05–5.45).
Frailty significantly impacts postoperative outcomes in patients undergoing THA, leading to increased complications, in-hospital mortality, and prolonged hospital stays. A proactive approach for managing frailty could lead to better resource utilization and enhanced recovery following THA.
Sandeep Appunni, Mukesh Roy, Krishna Raj Kunnath Rajappan et al.· Current Orthopaedic Practice· 0 citations
Background/Objectives: Frailty is increasingly recognized as a clinically relevant marker of reduced physiological reserve in surgical oncology. The modified 5-item frailty index (mFI-5) is simple and practical, but its clinical significance in oral squamous cell carcinoma (OSCC) remains incompletely defined. This study evaluated the association between mFI-5-defined frailty and postoperative complications, especially postoperative delirium, as well as survival outcomes in patients undergoing surgery for OSCC. Methods: We retrospectively analyzed 127 patients who underwent surgical resection for OSCC with postoperative high care unit (HCU) management between 2013 and 2021. Frailty was defined as an mFI-5 score of ≥2. Clinical characteristics, postoperative outcomes, HCU stay, length of hospital stay, overall survival (OS), and disease-free survival (DFS) were compared between frail and non-frail groups. Univariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for postoperative complications. An exploratory multivariable logistic regression analysis for postoperative delirium was performed using age ≥65 years and sex as covariates. Delirium was retrospectively assessed from clinical documentation considered consistent with DSM-5 criteria. Results: Twenty-one patients (16.5%) were classified as frail. Postoperative delirium occurred more frequently in frail patients than in non-frail patients (42.9% vs. 19.8%; p = 0.023). In a multivariable logistic regression model adjusted for age ≥65 years and sex, mFI-5-defined frailty was significantly associated with postoperative delirium (adjusted OR, 3.07; 95% CI, 1.08–8.60; p = 0.035). No significant association was observed for pneumonia, surgical site infection, or free-flap reoperation. Frailty was not significantly associated with HCU stay, length of hospital stay, OS, or DFS. Conclusions: mFI-5-defined frailty was associated with postoperative delirium but not with survival outcomes in this OSCC cohort. Because this retrospective study was limited by sample size, comorbidity-driven mFI-5 scoring, non-standardized delirium screening, and potential residual confounding, mFI-5 should be interpreted as a convenient screening marker rather than a stand-alone predictor. Comprehensive perioperative assessment incorporating frailty, nutrition, sarcopenia, cognition, tumor burden, and treatment-related factors may better identify patients at risk.
K. Yamagata, S. Fukuzawa, Shohei Takaoka et al.· Diagnostics· 0 citations
