S1352 Impact of Frailty and Post-EGD Complications in Variceal Bleeds: An Analysis of the National Readmission Database

Introduction: Frail patients are predisposed to poorer outcomes over a wide range of disease states. A clinical failure to recognize frailty in the hospital setting leads to increased morbidity. Variceal bleeding is often associated with high mortality and patients must undergo emergent endoscopy (EGD) to ensure hemostasis. We predict that frail patients with variceal bleeding would be subject to worse post-EGD complications. Methods: We analyzed the Nationwide Readmission Database (NRD) from 2016 to 2020 for patients with a history of variceal bleeding requiring EGD with or without intervention. Patients were then stratified by frailty based on the Gilbert Frailty risk score with a moderate to high-risk frailty score categorized as frail and a low-risk score categorized as non-frail. The primary outcome was all-cause in-patient mortality with secondary outcomes including readmission time, hospital length of stay, and hospital costs. Post-procedural complications were grouped and analyzed via a systems-based approach. Results: In total, 7,149 patients met our inclusion criteria with the frail group (n = 2,668, 37%) comprising the minority compared to the non-frail group (n = 4,482, 63%). Patients with frailty had a higher all-cause-inpatient-mortality (odds ratio [OR]: 4.84, 95% confidence interval [CI]: [3.34-7.00], P < 0.001]). Frail patients were also more likely to be readmitted (OR: 1.32, 95% CI [1.07-1.63], P = 0.009). System-based complication rates were found to be higher in frail patients with gastrointestinal complications (OR: 4.22, 95% CI [3.02-5.88], P < 0.001) and respiratory complications (OR: 5.12, 95% CI [4.08–6.41], P < 0.001) among the most significant. Conclusion: Overall, frail patients with variceal hemorrhage who underwent EGD had a higher all-cause in-hospital mortality. In this same population, patients admitted to the hospital were more likely to be readmitted within 30 days of discharge, a longer length of stay, and have significantly higher rate of complications.