In-hospital outcomes of percutaneous ablative therapy for colorectal cancer liver metastasis in patients with and without frailty: nationwide inpatient sample analysis 2005-2020

Percutaneous ablative therapies are widely used to treat colorectal liver metastases (CRLM), particularly in patients who are not candidates for surgical resection. Frailty has been associated with poor outcomes in colorectal cancer (CRC) and liver resections. This study aimed to evaluate the clinical impact of frailty on short-term outcomes in patients undergoing percutaneous ablative therapies for CRLM. This population-based, retrospective study used data from the US Nationwide Inpatient Sample database (2005-2020). Adults aged ≥ 50 years diagnosed with CRLM who underwent percutaneous ablative therapies were included. Frailty was confirmed using the Hospital Frailty Risk Score (HFRS). Associations between frailty and in-hospital mortality, length of hospital stay (LOS), non-home discharge, total hospital charges, and postoperative complications were evaluated using univariate and multivariable regression analyses. A total of 670 patients (mean age: 66.3 years) were included, of whom 23% were categorized as frail (HFRS ≥ 5). Multivariable analysis showed that frail patients had significantly increased risks of complications (adjusted odds ratio [aOR] = 4.80, 95% confidence interval [CI]: 3.04-7.59), longer LOS (adjusted Beta [aBeta] = 1.69 days, 95% CI: 1.68-1.70), and higher total hospital charges (aBeta = $22.04 thousand, 95% CI: $21.92-$22.16). Complications with the highest risks in frail patients included, sepsis/shock (aOR = 17.39), surgical site infection (aOR = 3.55), respiratory failure/mechanical ventilation (aOR = 4.43), acute kidney injury (aOR = 9.37), and bleeding (aOR = 4.79). In conclusion, in adults aged ≥ 50 years undergoing percutaneous ablative therapies for CRLM, frailty independently predicted worse short-term outcomes, including higher complication rates, longer LOS, and increased hospital charges. The absence of detailed tumor characteristics and specific types of ablative therapy performed underscores the need for further research.