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Frailty Is Independently Associated with Mortality and Readmission in Hospitalized Patients with Inflammatory Bowel Diseases

  • Author Footnotes
    a Authors share co-first authorship.
    Alexander S. Qian
    Footnotes
    a Authors share co-first authorship.
    Affiliations
    Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California
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  • Author Footnotes
    a Authors share co-first authorship.
    Nghia H. Nguyen
    Footnotes
    a Authors share co-first authorship.
    Affiliations
    Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California
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  • Jessica Elia
    Affiliations
    Expert Rehabilitation Services
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  • Lucila Ohno-Machado
    Affiliations
    Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
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  • William J. Sandborn
    Affiliations
    Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California
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  • Siddharth Singh
    Correspondence
    Reprint requests Address requests for reprints to: Siddharth Singh, MD, MS, Division of Gastroenterology, University of California San Diego, 9452 Medical Center Drive, ACTRI 1W501, La Jolla, California 92093. fax: (858) 657-7259.
    Affiliations
    Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California

    Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
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  • Author Footnotes
    a Authors share co-first authorship.
Published:August 11, 2020DOI:https://doi.org/10.1016/j.cgh.2020.08.010

      Background & Aims

      Old age must be considered in weighing the risks of complications vs benefits of treatment for patients with inflammatory bowel diseases (IBD). We conducted a nationally representative cohort study to estimate the independent effects of frailty on burden, costs, and causes for hospitalization in patients with IBD.

      Methods

      We searched the Nationwide Readmissions Database to identify 47,402 patients with IBD, hospitalized from January through June 2013 and followed for readmission through December 31, 2013. Based on a validated hospital frailty risk scoring system, 15,507 patients were considered frail and 31,895 were considered non-frail at index admission. We evaluated the independent effect of frailty on longitudinal burden and costs of hospitalization, inpatient mortality, risk of readmission and surgery, and reasons for readmission.

      Results

      Over a median follow-up time of 10 months, adjusting for age, sex, income, comorbidity index, depression, obesity, severity, and indication for index hospitalization, frailty was independently associated with 57% higher risk of mortality (adjusted hazard ratio [aHR], 1.57; 95% CI, 1.34–1.83), 21% higher risk of all-cause readmission (adjusted hazard ratio [HR], 1.21; 95% CI, 1.17–1.25), and 22% higher risk of readmission for severe IBD (aHR, 1.22; 95% CI, 1.16–1.29). Frail patients with IBD spent more days in the hospital annually (median 9 days; interquartile range, 4–18 days vs median 5 days for non-frail patients; interquartile range, 3–10 days; P < .01) with higher costs of hospitalization ($17,791; interquartile range, $8368–$38,942 vs $10,924 for non-frail patients, interquartile range, $5571–$22,632; P < .01). Infections, rather than IBD, were the leading cause of hospitalization for frail patients.

      Conclusions

      Frailty is independently associated with higher mortality and burden of hospitalization in patients with IBD; infections are the leading cause of hospitalization. Frailty should be considered in treatment approach, especially in older patients with IBD.

      Graphical abstract

      Keywords

      Abbreviations used in this paper:

      aHR (adjusted hazard ratio), CCI (Charlson Comorbidity Index), CCS (Clinical Classifications Software), HCUP (Healthcare Cost and Utilization Project), IBD (inflammatory bowel disease), ICD-9-CM (International Classification of Diseases, 9th Revision-Clinical Modification), NRD (Nationwide Readmissions Database)
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