Association of Frailty and Perioperative Outcomes Across Surgical Specialties Between 2016 and 2018 Using the National Inpatient Sample Database: A Retrospective Cohort Study

Background and Aims: Frailty is associated with adverse surgical outcomes in older adults, but it remains unknown if this association is consistent across all surgical specialties. This study aimed to evaluate the relationship between frailty and postoperative outcomes across surgical specialties using the National Inpatient Sample (NIS) database. Methods: The NIS database between 2016 and 2018 was queried to analyze surgical admissions for patients over 65 years old. Frailty was assessed using the Hospital Frailty Risk Score (HFRS), categorizing patients into low (< 5), intermediate (5-15), and high (> 15) risk groups. Our primary outcome was in-hospital mortality, and our secondary outcome was nonhome discharge. Multivariable logistic regression was performed to determine the association between frailty and our outcomes. Results: Among 1,826,285 surgical admissions that met the inclusion criteria, 65.0% were classified as low frailty risk, 32.0% as intermediate risk, and 3.0% as high risk. Higher frailty scores were associated with increased in-hospital mortality (intermediate risk: OR 9.61, 95% CI: 8.96-10.30; high risk: OR 24.58, 95% CI: 21.55-28.04) and higher odds of nonhome discharge (intermediate risk: OR 2.99, 95% CI: 2.94-3.04; high risk: OR 14.82, 95% CI: 13.64-16.10). Frail patients underwent emergent procedures at significantly higher rates than nonfrail patients (91.3% vs. 26.3%). In sensitivity analyses, frail patients consistently demonstrated increased levels of in-hospital mortality and nonhome discharge across all surgical subspecialties. Conclusions: Frailty, as measured by the HFRS, is strongly associated with increased in-hospital mortality and nonhome discharge across surgical subspecialties, especially in emergent settings. Our study demonstrates the need to account for frailty to inform patient-centered care and enhance surgical decision making.