Impact of frailty on inpatient outcomes in thyroid cancer surgery: 10-year results from the U.S. national inpatient sample

Abstract

Background: Frailty is linked to perioperative morbidity and mortality. We evaluated the impact of preoperative frailty on inpatient outcomes of patients undergoing surgery for thyroid malignancy. Methods: This population-based, retrospective observational study extracted data of hospitalized patients who were 18 years and older with a primary diagnosis of thyroid cancer undergoing thyroidectomy from the US Nationwide Inpatient Sample (NIS) database (2005-2014). Participants were stratified into frail and non-frail using the Johns Hopkins (ACG) frailty-defining diagnosis indicator. Study endpoints were in-hospital mortality, incidence of surgical and medical complications and prolonged length of stay. Univariate and multivariate analysis were performed to determine associations between the endpoints and frailty. Results: Data of 38,202 patients were included. After adjusting for possible confounders, frailty remained significantly associated with higher odds of in-hospital mortality (OR: 3.839, 95% CI: 1.738-8.480), prolonged length of stay (OR: 5.420, 95% CI: 3.799-7.733), surgical complications (OR: 3.144, 95% CI: 2.443-4.045) and medical complications (OR: 6.734, 95% CI: 5.099-8.893) compared with non-frailty. In patients > age 65 years, adjusted odds ratio for frailty was 4.099 (95% CI: 1.736-9.679) for in-hospital mortality, 6.164 (95% CI: 3.514-10.812) for prolonged length of stay, 3.736 (95% CI: 2.620-5.328) for surgical complications, and 5.970, 95% CI: 4.088-8.720 for medical complications, all with significance. Conclusion: Frailty is associated with increased risk for adverse inpatient outcomes, including prolonged hospital stay, surgical and medical complications and mortality independent of age and comorbidities in thyroid cancer patients undergoing surgery. Study findings may provide valuable information for preoperative risk stratification.

Frailty Among Total Hip and Knee Arthroplasty Recipients: Epidemiology and Propensity Score-weighted Analysis of Effect on In-hospital Postoperative Outcomes

“…21, 783.22), muscular wasting and disuse atrophy (728.2), senility without mention of psychosis (797), and malaise and fatigue (780.79), as validated in previous studies. [9][10][11][12][13] To balance the covariates and minimize the effect of confounding bias as well as adjust for the severity of comorbidities, the inverse probability of treatment weighting (IPTW) with complex survey data was used. Propensity score weighting was done per the method of DuGoff et al by weighting patient demographics, hospital characteristics, and comorbidities using a modified version of the Elixhauser Comorbidity Index (ECI).…”

“…Frail patients were identified as those with at least one of the following ICD-9 codes: pressure ulcer (707.0X, 707.2X), cachexia (799.4), adult failure to thrive (783.7), muscle weakness (728.87), debility (799.3), difficulty in walking (719.7), history of fall (V15.88), abnormality of gait (781.2), anorexia (783.0), abnormal loss of weight and underweight (783.21, 783.22), muscular wasting and disuse atrophy (728.2), senility without mention of psychosis (797), and malaise and fatigue (780.79), as validated in previous studies. 9-13…”

The clinical impact of frailty on the postoperative outcomes of patients undergoing gastrectomy for gastric cancer: a propensity-score matched database study

“…Frailty was used as the exposure variable to divide the cohort into frailty-present and frailty-absent cohorts. Like previous National Inpatient Studies, this study employs the Johns Hopkins ACG definition of frailty [20][21][22], a diagnostic index composed of criteria, such as dementia, housing needs and homelessness, difficulties with ambulation, weight loss and feeding difficulties, vision impairment, frequent falls, urinary and fecal incontinence, malnutrition, and pressure ulcerations. The primary endpoints investigated in this study are mortality, length of stay, hospitalization costs, and disposition at discharge.…”

Total Thyroidectomy and Low-Risk Thyroid Cancer: Are We Treating the Surgeon or Patient?

“…Frailty as a measure of fitness for operation is associated with increased medical and surgical complications following inpatient thyroidectomy. 9 In his 2011 address as President of the American Association of Endocrine Surgeons, Dr. Douglas Evans highlighted some of the key issues in the management of papillary thyroid cancer (PTC). 10 Once more sensitive indicators of recurrence of PTC, i.e., ultrasound and measurements of thyroglobulin (Tg), became available, there was greater interest in performing larger operations to eradicate clinically evident disease.…”