Hospital Frailty Risk Score and in-hospital mortality after pancreatectomy in adults ≥65: A national analysis (NIS 2020–2022).

Abstract

738 Background: Frailty reflects physiological vulnerability and has emerged as a potent predictor of adverse surgical outcomes. In pancreatic cancer, pancreatectomy offers the only potential cure but carries high perioperative risk, particularly for older adults. While comorbidity indices are commonly used in risk assessment, the incremental prognostic value of frailty, measured with the Hospital Frailty Risk Score (HFRS), has not been well characterized in this setting. Methods: We conducted a cross-sectional analysis using the 2020–2022 National Inpatient Sample to identify adults aged ≥65 years with pancreatic cancer who underwent pancreatectomy. Frailty was measured using the HFRS, categorized as low (<5), intermediate (5–15), or high (>15). We applied survey-weighted methods accounting for complex sampling design to describe baseline characteristics, estimate in-hospital mortality rates, and compare mortality across frailty categories. Weighted logistic regression models examined associations between frailty and mortality, adjusting for age, sex, and Charlson Comorbidity Index (CCI). Results: The cohort included 3,637 unweighted discharges, representing 18,185 weighted hospitalizations. Weighted prevalence of frailty categories was 67.8% (95% CI 66.0–69.5) low, 29.9% (28.2–31.6) intermediate, and 2.31% (1.87–2.85) high frailty. In-hospital mortality increased markedly with frailty severity: 0.28% (0.07–0.49) for low, 5.24% (3.91–6.57) for intermediate, and 17.86% (9.59–26.12) for high frailty (p<0.001). In adjusted analyses, each one-point increase in HFRS was associated with a 27% higher odds of death (OR 1.27, 95% CI 1.23–1.32, p<0.001). Conclusions: Frailty is a strong stratifier of perioperative mortality risk in older adults undergoing pancreatectomy for pancreatic cancer, independent of age and comorbidity burden. Even intermediate frailty was associated with a nearly 20-fold higher mortality compared with low frailty. These findings underscore the clinical importance of frailty screening in preoperative counseling, patient selection, and optimization strategies for high-risk surgical oncology patients. Frailty distribution and in-hospital mortality after pancreatectomy (adults ≥65), NIS 2020–2022. Frailty (HFRS) Weighted prevalence % (95% CI) In-hospital mortality % (95% CI) Low (<5) 67.8 (66.0–69.5) 0.28 (0.07–0.49) Intermediate (5–15) 29.9 (28.2–31.6) 5.24 (3.91–6.57) High (>15) 2.31 (1.87–2.85) 17.86 (9.59–26.12) HFRS = Hospital Frailty Risk Score from ICD-10 coding. Estimates are survey-weighted to reflect national hospitalizations.