Post written by Camilo J. Acosta, MD David Goldberg, MD Sunil Amin, MD, MPH, from the Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA and Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA.
Frailty is common and has been extensively studied as a robust predictor of clinical outcomes in the context of major surgeries as well as various disease states, such as cirrhosis. We aimed to determine the association between frailty status using the Hospital Frailty Risk Score (HFRS) and risk of adverse events in hospitalized patients with GI bleeding who underwent endoscopy.
Although efforts to incorporate frailty measurement tools into general clinical practice have increased in recent years, few studies have looked at the association between frailty and GIB and even less have investigated the utility of frailty as a modality to assess patient risk related to endoscopy. Gastroenterologists will try to avoid subjecting patients to an endoscopy that will not necessarily be therapeutic, while the recommendation to pursue endoscopic procedures is often from the singular lens of the benefits of endoscopy without the counterbalanced risk of the procedure. We wanted to explore the benefit of frailty assessment in answering the question: When is someone with a GIB too frail to have an endoscopic procedure?
The main takeaway from our study is that we show frailty assessment can be used as a marker to predict outcomes in patients with gastrointestinal bleeding who are being considered for endoscopy—either upper endoscopy or colonoscopy. Over 700,000 hospitalized patients with GIB who underwent endoscopy were represented in our study with 44% of them being classified as frail, further highlighting the prevalence of frailty in ubiquitous conditions such as GI hemorrhage. Among this patient population, we found that frail patients had an almost 2-fold increase in the proportion of periprocedural adverse events including all-cause mortality compared to non-frail patients.
These results are impactful in the sense that they show we should be evaluating the frailty status of patients. Using this type of evaluation can serve as a helpful guide to determine who is at increased risk for doing poorly with endoscopic interventions and thus can help us have better discussions with patients about benefits of therapies versus risks. We used the Hospital Frailty Risk Score (HFRS) in our study, which although recognized as a robust frailty measure, involves a large quantity of administrative codes and is not incorporated into current electronic medical records. Future efforts should therefore be focused on the development of a rapid clinical calculator to assist in the decision-making process and to translate the HFRS into a simpler, readily available tool.
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