Introduction: This study aimed to evaluate associations between frailty and outcomes in patients with intrahepatic cholangiocarcinoma (ICC) undergoing hepatic lobectomy using a large, nationally representative sample. Methods: This population-based, retrospective observational study extracted the data of adults ≥20 years old with ICC undergoing hepatic lobectomy from the US Nationwide Inpatient Sample database between 2005 and 2018. Frailty was assessed by the validated Hospital Frailty Risk Score (HFRS). Associations between frailty and surgical outcomes were analyzed using logistic regression analyses. Results: After exclusions, 777 patients were enrolled, including 427 frail and 350 non-frail. Patients’ mean age was 64.5 (±0.4) years and the majority were males (51.1%) and whites (76.5%). Frailty was significantly associated with increased odds of in-hospital mortality (aOR: 18.51, 95% CI: 6.70, 51.18), non-home discharge (aOR: 3.58, 95% CI: 2.26, 5.66), prolonged LOS (aOR: 5.56, 95% CI: 3.87, 7.99), perioperative cardiac arrest/stroke (aOR: 5.44, 95% CI: 1.62, 18.24), acute respiratory distress syndrome (ARDS)/respiratory failure (aOR: 3.88, 95% CI: 2.40, 6.28), tracheostomy/ventilation (aOR: 3.83, 95% CI: 2.23, 6.58), bleeding/transfusion (aOR: 1.67, 95% CI: 1.24, 2.26), acute kidney injury (AKI) (aOR: 14.37, 95% CI: 7.13, 28.99), postoperative shock (aOR: 4.44, 95% CI: 2.54, 7.74), and sepsis (aOR: 11.94, 95% CI: 6.90, 20.67). Discussion/Conclusion: Among patients with ICC undergoing hepatic lobectomy, HFRS-defined frailty is a strong predictor of worse in-patient outcomes, including in-hospital death, prolonged LOS, unfavorable discharge, and complications (perioperative cardiac arrest/stroke, ARDS/respiratory failure, tracheostomy/ventilation, bleeding/transfusion, AKI, postoperative shock, and sepsis). Study results may help stratify risk in frail patients undergoing hepatic resection for ICC.

1.
Patel
T
.
Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States
.
Hepatology
.
2001
;
33
(
6
):
1353
7
. .
2.
Razumilava
N
,
Gores
GJ
.
Cholangiocarcinoma
.
Lancet
.
2014
;
383
(
9935
):
2168
79
. .
3.
Uhlig
J
,
Sellers
CM
,
Cha
C
,
Khan
SA
,
Lacy
J
,
Stein
SM
, et al
.
Intrahepatic cholangiocarcinoma: socioeconomic discrepancies, contemporary treatment approaches and survival trends from the national cancer database
.
Ann Surg Oncol
.
2019
;
26
(
7
):
1993
2000
. .
4.
Yu
TH
,
Chen
X
,
Zhang
XH
,
Zhang
EC
,
Sun
CX
.
Clinicopathological characteristics and prognostic factors for intrahepatic cholangiocarcinoma: a population-based study
.
Sci Rep
.
2021
;
11
(
1
):
3990
. .
5.
Lee
AJ
,
Chun
YS
.
Intrahepatic cholangiocarcinoma: the AJCC/UICC 8th edition updates
.
Chin Clin Oncol
.
2018
;
7
(
5
):
52
. .
6.
Fostea
RM
,
Fontana
E
,
Torga
G
,
Arkenau
HT
.
Recent progress in the systemic treatment of advanced/metastatic cholangiocarcinoma
.
Cancers
.
2020
;
12
(
9
):
2599
. .
7.
Valle
JW
.
Targeted therapy for cholangiocarcinoma
.
Lancet Gastroenterol Hepatol
.
2019
;
4
(
9
):
661
2
. .
8.
Zhang
XF
,
Xue
F
,
Dong
DH
,
Weiss
M
,
Popescu
I
,
Marques
HP
, et al
.
Number and station of lymph node metastasis after curative-intent resection of intrahepatic cholangiocarcinoma impact prognosis
.
Ann Surg
.
2021
;
274
(
6
):
e1187
95
. .
9.
Zhu
H
,
Ji
K
,
Wu
W
,
Zhao
S
,
Zhou
J
,
Zhang
C
, et al
.
Describing treatment patterns for elderly patients with intrahepatic cholangiocarcinoma and predicting prognosis by a validated model: a population-based study
.
J Cancer
.
2021
;
12
(
11
):
3114
25
. .
10.
Robinson
TN
,
Wu
DS
,
Pointer
L
,
Dunn
CL
,
Cleveland
JC
Jr
,
Moss
M
.
Simple frailty score predicts postoperative complications across surgical specialties
.
Am J Surg
.
2013
;
206
(
4
):
544
50
. .
11.
Lin
HS
,
Watts
JN
,
Peel
NM
,
Hubbard
RE
.
Frailty and post-operative outcomes in older surgical patients: a systematic review
.
BMC Geriatr
.
2016
;
16
(
1
):
157
. .
12.
Tanaka
S
,
Ueno
M
,
Iida
H
,
Kaibori
M
,
Nomi
T
,
Hirokawa
F
, et al
.
Preoperative assessment of frailty predicts age-related events after hepatic resection: a prospective multicenter study
.
J Hepatobiliary Pancreat Sci
.
2018
;
25
(
8
):
377
87
. .
13.
Elsamadicy
AA
,
Koo
AB
,
Reeves
BC
,
Pennington
Z
,
Yu
J
,
Goodwin
CR
, et al
.
Hospital Frailty Risk Score and healthcare resource utilization after surgery for metastatic spinal column tumors
.
J Neurosurg Spine
.
2022
;
37
(
2
):
241
51
. .
14.
Noor
A
,
Gibb
C
,
Boase
S
,
Hodge
JC
,
Krishnan
S
,
Foreman
A
.
Frailty in geriatric head and neck cancer: a contemporary review
.
Laryngoscope
.
2018
;
128
(
12
):
E416
24
. .
15.
Komici
K
,
Bencivenga
L
,
Navani
N
,
D'Agnano
V
,
Guerra
G
,
Bianco
A
, et al
.
Frailty in patients with lung cancer: a systematic review and meta-analysis
.
Chest
.
2022
;
162
(
2
):
485
97
. .
16.
Tsai
HH
,
Yu
JC
,
Hsu
HM
,
Chu
CH
,
Hong
ZJ
,
Feng
AC
, et al
.
The impact of frailty on breast cancer outcomes: evidence from analysis of the Nationwide Inpatient Sample, 2005-2018
.
Am J Cancer Res
.
2022
;
12
(
12
):
5589
98
.
17.
Gilbert
T
,
Neuburger
J
,
Kraindler
J
,
Keeble
E
,
Smith
P
,
Ariti
C
, et al
.
Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study
.
Lancet
.
2018
;
391
(
10132
):
1775
82
. .
18.
Powell-Cope
G
,
Nelson
AL
,
Patterson
ES
.
Patient care technology and safety
. In:
Hughes
RG
, editor.
Patient safety and quality: an evidence-based handbook for nurses
.
Rockville (MD)
;
2008
.
19.
Gilbert
T
,
Cordier
Q
,
Polazzi
S
,
Bonnefoy
M
,
Keeble
E
,
Street
A
, et al
.
External validation of the hospital frailty risk score in France
.
Age Ageing
.
2022
;
51
(
1
):
afab126
. .
20.
Nghiem
S
,
Afoakwah
C
,
Scuffham
P
,
Byrnes
J
.
Hospital frailty risk score and adverse health outcomes: evidence from longitudinal record linkage cardiac data
.
Age Ageing
.
2021
;
50
(
5
):
1778
84
. .
21.
Kilkenny
MF
,
Phan
HT
,
Lindley
RI
,
Kim
J
,
Lopez
D
,
Dalli
LL
, et al
.
Utility of the hospital frailty risk score derived from administrative data and the association with stroke outcomes
.
Stroke
.
2021
;
52
(
9
):
2874
81
. .
24.
Sugiura
T
,
Uesaka
K
,
Okamura
Y
,
Ito
T
,
Yamamoto
Y
,
Ashida
R
, et al
.
Major hepatectomy with combined vascular resection for perihilar cholangiocarcinoma
.
BJS Open
.
2021
;
5
(
4
):
zrab064
. .
25.
Benzing
C
,
Haiden
LM
,
Krenzien
F
,
Mieg
A
,
Wolfsberger
A
,
Atik
CF
, et al
.
Textbook outcome after major hepatectomy for perihilar cholangiocarcinoma: definitions and influencing factors
.
Langenbecks Arch Surg
.
2022
;
407
(
4
):
1561
73
. .
26.
Hoogendijk
EO
,
Afilalo
J
,
Ensrud
KE
,
Kowal
P
,
Onder
G
,
Fried
LP
.
Frailty: implications for clinical practice and public health
.
Lancet
.
2019
;
394
(
10206
):
1365
75
. .
27.
Fried
LP
,
Tangen
CM
,
Walston
J
,
Newman
AB
,
Hirsch
C
,
Gottdiener
J
, et al
.
Frailty in older adults: evidence for a phenotype
.
J Gerontol A Biol Sci Med Sci
.
2001
;
56
(
3
):
M146
56
. .
28.
Cespedes Feliciano
EM
,
Hohensee
C
,
Rosko
AE
,
Anderson
GL
,
Paskett
ED
,
Zaslavsky
O
, et al
.
Association of prediagnostic frailty, change in frailty status, and mortality after cancer diagnosis in the women's health initiative
.
JAMA Netw Open
.
2020
;
3
(
9
):
e2016747
. .
29.
Woods
NF
,
LaCroix
AZ
,
Gray
SL
,
Aragaki
A
,
Cochrane
BB
,
Brunner
RL
, et al
.
Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study
.
J Am Geriatr Soc
.
2005
;
53
(
8
):
1321
30
. .
30.
Brundle
C
,
Heaven
A
,
Brown
L
,
Teale
E
,
Young
J
,
West
R
, et al
.
Convergent validity of the electronic frailty index
.
Age Ageing
.
2019
;
48
(
1
):
152
6
. .
31.
Ramai
D
,
Dang-Ho
KP
,
Kewalramani
A
,
Bandaru
P
,
Sacco
R
,
Giacomelli
L
, et al
.
Hospital frailty risk score is independently associated with mortality and encephalopathy in hospitalized patients with hepatocellular carcinoma
.
Biomedicines
.
2021
;
9
(
11
):
1693
. .
32.
Madrigal
J
,
Hadaya
J
,
Lee
C
,
Tran
Z
,
Benharash
P
.
Association of frailty with perioperative outcomes following hepatic resection: a national study
.
J Am Med Dir Assoc
.
2022
;
23
(
4
):
684
9.e1
. .
33.
Tokuda
K
,
Morine
Y
,
Miyazaki
K
,
Yamada
S
,
Saito
YU
,
Nishi
M
, et al
.
Frailty can predict prognosis after hepatectomy in patients with colorectal liver metastasis
.
Anticancer Res
.
2021
;
41
(
9
):
4637
44
. .
34.
Bartsch
F
,
Baumgart
J
,
Tripke
V
,
Hoppe-Lotichius
M
,
Heinrich
S
,
Lang
H
.
Resection of intrahepatic cholangiocarcinoma in elderly patients - is it reasonable
.
BMC Surg
.
2019
;
19
(
1
):
157
. .
35.
Komici
K
,
Cappuccio
M
,
Scacchi
A
,
Vaschetti
R
,
Delli Carpini
G
,
Picerno
V
, et al
.
The prevalence and the impact of frailty in hepato-biliary pancreatic cancers: a systematic review and meta-analysis
.
J Clin Med
.
2022
;
11
(
4
):
1116
. .
36.
Limpawattana
P
,
Wirasorn
K
,
Sookprasert
A
,
Sawanyawisuth
K
,
Titapun
A
,
Luvira
V
, et al
.
Frailty syndrome in biliary tract cancer patients: prevalence and associated factors
.
Asian Pac J Cancer Prev
.
2019
;
20
(
5
):
1497
501
. .
37.
Hosoda
K
,
Shimizu
A
,
Kubota
K
,
Notake
T
,
Masuo
H
,
Yoshizawa
T
, et al
.
Usefulness of frailty to predict short- and long-term outcomes in patients who have undergone major hepatectomy for perihilar cholangiocarcinoma
.
Ann Gastroenterol Surg
.
2022
;
6
(
6
):
833
41
. .
You do not currently have access to this content.