IMPACT OF FRAILTY ON PER ORAL ENDOSCOPIC MYOTOMY(POEM): A NATIONAL DATABASE ANALYSIS

Introduction: Frailty remains an important risk factor for increased morbidity and mortality in the inpatient setting. The impact of frailty on clinical outcomes in patients undergoing Peroral Endoscopic Myotomy (POEM) is not well established. We aim to determine the association between frailty and adverse events in patients hospitalized for POEM procedure.

Methods: We conducted a cohort study using data from the National Inpatient Sample (NIS) for the years 2017 to 2019. Adult patients who underwent POEM following hospitalization were identified using International Classification of Diseases (ICD) diagnostic codes. The Hospital Frailty Risk Score (HFRS) was used to classify patients as Frail or Non-Frail. Multivariable logistic regression analysis was performed to compare outcomes between these groups. Discharge weights were applied to provide national estimates.
Results: 1,735 patients met the inclusion criteria, with 1515 patients (87.3%) identified as non-frail and 220 as frail (12.7%). Frail patients had higher Charlson Comorbidity Index (CCI) compared to non-frail patients. The baseline characteristics of both groups are compared in Table1. Frail patients who underwent POEM had higher inpatient mortality compared to non-frail patients who had POEM procedure (2.2 % vs 0.0%, p < 0.01). Frail patients also had a longer length of hospital stay (9.2 days vs 2.6 days, p <0.001), higher total charges (132,353$ vs 58,775 $, p < 0.05). In terms of systemic complications, frail patients had more cardiovascular (2.27% vs 0.00%, p < .01), thoracic (13.64% vs 2.97%, p < .01), and infectious (18.18% vs 2.64%, p <0.001) adverse events compared to non-frail patients. The incidence of patients requiring TPN was higher in frail (13.64 vs 1.32, p<0.001) compared to non-fail patients. When adjusted for age, gender, race, hospital location, teaching status, insurance, and Charlson co-morbidity index, frail patients had increased chances of requiring TPN [OR 13.49 (95% CI 2.00-91.25) p < .01], higher incidence of infectious [OR 17.38 (95% CI 5.22-57.91) p < .001] and thoracic [OR 5.75 (95% CI 1.75-18.92) p < .01] complications as well as increased LOS [ OR 6.56 (95% CI 3.64-9.47) p < .01] when compared to non-frail patients.
Conclusion: Frailty in patients undergoing POEM is associated with a greater frequency of TPN usage, systemic complications, longer hospital stays, higher healthcare costs, and increased in-hospital mortality. These findings emphasize the importance of frailty assessments in clinical decision-making for patients undergoing POEM.