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Frailty has been widely recognized as a predictor of postoperative outcomes. Given the paucity of standardized frailty measurements in thoracic procedures, we aimed to determine the impact of coding-based frailty on clinical outcomes and resource utilization following anatomic lung resection.
All adults undergoing elective, anatomic lung resections (segmentectomy, lobectomy, pneumonectomy) from 2005-2014 were identified using the National Inpatient Sample. Patients were categorized as Frail or Non-Frail based on the presence of any frailty-defining diagnoses defined by the Johns Hopkins Adjusted Clinical Groups. Multivariable models were used to assess the independent association of frailty with in-hospital mortality, non-home discharge, complications, duration of stay and costs.
Of an estimated 366,357 hospitalizations for elective lung resection during the study period, 4.4% were Frail. Patients who underwent pneumonectomy or were treated at low-volume hospitals were more commonly frail. Relative to Non-Frail, frailty was associated with increased unadjusted mortality (9.1% vs 1.7%, p<0.001) and non-home discharge (44.7% vs 10.5%, p<0.001). Frail patients had 3.47 increased adjusted odds of mortality across resection types (95% CI 2.94-4.09). Frailty conferred the greatest increase in mortality, complications and resource use following pneumonectomy relative to lobectomy or segmentectomy, though significant differences were evident for all three.
Frailty exhibits a strong association with inferior clinical outcomes and increased resource utilization following elective lung resection, particularly pneumonectomy. This readily available tool may improve preoperative risk assessment and allow for better selection of treatment modalities for frail patients with pulmonary pathologies.
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