Introduction The objective of this study was to identify sociodemographic factors associated with frailty and impact on postoperative outcomes.

Methods Women undergoing ovarian cancer debulking from 2016–2020 in the National Inpatient Sample were identified. Frailty was defined by a Hospital Frailty Risk Score (HFRS) >5, a weighted index surveying >50 social and medical comorbidities. Mortality and postoperative complications were identified using ICD-10 codes from same admission and classified as medical, surgical or infectious. Social and clinical demographic data were collected. Pearson’s chi-squared test and logistic regression analysis were performed. Odds ratios with 95% confidence intervals were calculated.

Results Of 12,926 women undergoing debulking, 1,829 (14%) were frail. Frailty was associated with prolonged hospitalization (p<0.001) and >1 postoperative complication (p<0.001). In univariate analysis, frailty was associated with race/ethnicity, age, income and insurance status (p < 0.01). In multivariate analysis, race/ethnicity were no longer associated with frailty (Black: 1.12; 95%CI 0.92–1.36; Hispanic: 0.99; 0.80–1.22) but low income (highest quartile income 0.76; 95%CI 0.7–0.9) and Medicaid as payor (1.3; 1.1–1.6) remained associated. Frail women were more likely to be treated in low ovarian cancer volume centers (high volume center 0.74; 0.64–0.85) and after controlling for frailty, treatment at a low ovarian cancer volume center was independently associated with postoperative complications (high volume treatment center 0.47; 0.41–0.53).

Conclusion/Implications Frailty was associated with adverse financial factors but not race/ethnicity. Frail women are more likely to be treated in low volume centers with independently higher rates of postoperative complications, indicating a disparity in access to care for this at-risk population.