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Original research
Frailty is independently associated with worse outcomes and increased resource utilization following endometrial cancer surgery
  1. Morcos Nakhla1,
  2. Cortney M Eakin1,
  3. Ava Mandelbaum2,
  4. Beth Karlan1,
  5. Peyman Benharash2,
  6. Ritu Salani1 and
  7. Joshua G Cohen1
  1. 1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
  2. 2Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
  1. Correspondence to Dr Joshua G Cohen, 3Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA; cohen.g.joshua{at}gmail.com

Abstract

Objective Frailty has been associated with poorer surgical outcomes and is a critical factor in procedural risk assessment. The objective of this study is to assess the impact of frailty on surgical outcomes in patients with endometrial cancer.

Methods Patients undergoing inpatient gynecologic surgery for endometrial cancer were identified using the 2005–2017 Nationwide Inpatient Sample database. The Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator was used to designate frailty. Multivariate regression models were used to assess the association of frailty with postoperative outcomes and resource use.

Results Of 339 846 patients, 2.9% (9868) were considered frail. After adjusting for patient and hospital characteristics, frailty was associated with a four-fold increase in inpatient mortality (adjusted OR (aOR) 4.1; p<0.001), non-home discharge (aOR 5.2; p<0.001), as well as increased respiratory (aOR 2.6; p<0.001), neurologic (aOR 3.3; p<0.001), renal (aOR 2.0; p<0.001), and infectious (aOR 3.2; p<0.001) complications. While frail patients exhibited increased mortality with age, the rate of mortality in this cohort decreased significantly over time. Compared with non-frail counterparts, frail patients had longer lengths of stay (7.6 vs 3.4 days; p<0.001) and increased hospitalization costs with surgical admission ($25 093 vs $13 405; p<0.001).

Conclusions Frailty is independently associated with worse surgical outcomes, including increased mortality and resource use, in women undergoing surgery for endometrial cancer. Though in recent years there have been improvements in mortality in the frail population, further efforts to mitigate the impact of frailty should be explored.

  • Gynecologic Surgical Procedures
  • Uterine Cancer

Data availability statement

Data are available in a public, open access repository. Data obtained from the 2005-2017 National Inpatient Sample (NIS) database developed for the Healthcare Cost and Utilization Project (HCUP) and sponsored by the Agency for Healthcare Research and Quality (AHRQ). Data available at https://www.hcup-us.ahrq.gov/

https://doi.org/10.1136/ijgc-2022-003484

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    Data availability statement

    Data are available in a public, open access repository. Data obtained from the 2005-2017 National Inpatient Sample (NIS) database developed for the Healthcare Cost and Utilization Project (HCUP) and sponsored by the Agency for Healthcare Research and Quality (AHRQ). Data available at https://www.hcup-us.ahrq.gov/

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    Footnotes

    • Twitter @JCohenMD

    • Contributors The authors confirm contribution to the paper as follows: MN: study conception and design, data collection, analysis and interpretation of results, draft manuscript preparation. CME: interpretation and draft manuscript preparation and revision. AM: data collection and analysis and manuscript revision. BK: Interpretation and manuscript revision. RS: interpretation of results, draft manuscript preparation and revision. PB: study conception and design, revision of manuscript. JGC: guarantor, study conception and design, analysis, interpretation of results, draft manuscript preparation and revisions.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.