Assessing the Impact of Frailty on Healthcare Burden Post-Surgery in Head and Neck Cancer Patients
Author(s)
Dhanish Revanth Rangaswamy Nandakumar, MPH1, Nishi Yadav, MS2, Bhargavi Mahadik, MS1, Ambarish J. Ambegaonkar, PhD1;
1APPERTURE LLC, Marlboro, NJ, USA, 2APPERTURE LLC, New Delhi, India
1APPERTURE LLC, Marlboro, NJ, USA, 2APPERTURE LLC, New Delhi, India
OBJECTIVES: Head and neck cancers (HNC) constitute 4% of all cancers and 2% of all cancer-deaths in the US. Frailty, characterized as a multifactorial state of physiological decline and increased susceptibility to adverse outcomes as an important factor influencing treatment outcomes. This study aims to assess the healthcare burden associated with frailty in HNC patients following their first surgical hospitalization.
METHODS: The 2019 Nationwide Readmissions Database (NRD) was used to identify patients hospitalized for HNC surgery utilizing ICD 10 codes. 30-day readmission was the main outcome variable along with length of stay (LOS) and total hospital charges (THC). Frailty index was computed from relevant ICD 10 codes. Hypothesis testing was conducted to test baseline characteristic differences between patients with and without 30-day readmission while multiple linear and multivariable logistic regressions estimated association between frailty and outcomes of interest.
RESULTS: The 2019 NRD identified 5,639 patients, of which 12% (n=650) had a re-admission within 30 days which was either unplanned or due to poor primary surgical outcomes. These patients were typically older, predominantly male, and were more often in the lowest income quartile ($1-$47,999). Adjusting for sociodemographic and clinical characteristics, frailty was significantly associated with LOS and TCH leading to 12% [1.12 (1.10, 1.14)] and 10% [1.095 (1.07, 1.12)] increase in index hospitalization LOS and THC. Majority of the re-hospitalized patients (n=591) had only 1 incident readmission with an average per person cost of $76,027. After adjusting for number of procedures, disposition from hospital and LOS, multivariable logistic regression reported frailty to be significantly associated with 30-day readmissions resulting in 25% increased odds of readmission [aOR (95% CI)] [1.25 (1.02, 1.54)].
CONCLUSIONS: Frailty adds significant incremental economic burden to the HNC patients’ primary hospitalization for surgery, while increasing multiple fold their risk of adverse outcomes and subsequent costly rehospitalizations.
METHODS: The 2019 Nationwide Readmissions Database (NRD) was used to identify patients hospitalized for HNC surgery utilizing ICD 10 codes. 30-day readmission was the main outcome variable along with length of stay (LOS) and total hospital charges (THC). Frailty index was computed from relevant ICD 10 codes. Hypothesis testing was conducted to test baseline characteristic differences between patients with and without 30-day readmission while multiple linear and multivariable logistic regressions estimated association between frailty and outcomes of interest.
RESULTS: The 2019 NRD identified 5,639 patients, of which 12% (n=650) had a re-admission within 30 days which was either unplanned or due to poor primary surgical outcomes. These patients were typically older, predominantly male, and were more often in the lowest income quartile ($1-$47,999). Adjusting for sociodemographic and clinical characteristics, frailty was significantly associated with LOS and TCH leading to 12% [1.12 (1.10, 1.14)] and 10% [1.095 (1.07, 1.12)] increase in index hospitalization LOS and THC. Majority of the re-hospitalized patients (n=591) had only 1 incident readmission with an average per person cost of $76,027. After adjusting for number of procedures, disposition from hospital and LOS, multivariable logistic regression reported frailty to be significantly associated with 30-day readmissions resulting in 25% increased odds of readmission [aOR (95% CI)] [1.25 (1.02, 1.54)].
CONCLUSIONS: Frailty adds significant incremental economic burden to the HNC patients’ primary hospitalization for surgery, while increasing multiple fold their risk of adverse outcomes and subsequent costly rehospitalizations.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
SA17
Topic
Study Approaches
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology