What is the clinical evidence from this study?

Study design: Cohort. Population: Surgical admissions (n=1826285). Intervention: Frailty (Hospital Frailty Risk Score) vs. Low frailty risk. Primary outcome: In-hospital mortality (OR 24.58 (high risk), 95% CI 21.55-28.04).

What does this research mean for the field?

Higher frailty scores are associated with increased in-hospital mortality and higher odds of nonhome discharge across surgical specialties in older adults. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

The study aims to assess the relationship between frailty and postoperative outcomes across different surgical specialties in older adults.

February 12, 2026Open Access

Association of Frailty and Perioperative Outcomes Across Surgical Specialties Between 2016 and 2018 Using the National Inpatient Sample Database: A Retrospective Cohort Study

Key Result

High frailty risk was strongly associated with increased in-hospital mortality compared to low frailty risk (OR 24.58; 95% CI 21.55-28.04) across surgical specialties.

Key Points

The study aims to assess the relationship between frailty and postoperative outcomes across different surgical specialties in older adults.
Utilized National Inpatient Sample database from 2016 to 2018.
Analyzed surgical admissions for patients over 65 years old.
Assessed frailty using the Hospital Frailty Risk Score, categorizing into risk groups.
Performed multivariable logistic regression to determine associations with outcomes.
65.0% of admissions categorized as low frailty risk, 32.0% as intermediate, and 3.0% as high risk.
Higher frailty scores linked to increased in-hospital mortality (intermediate risk: OR 9.61; high risk: OR 24.58).
Higher odds of nonhome discharge for frail patients (intermediate risk: OR 2.99; high risk: OR 14.82).
Frail patients underwent emergent procedures at much higher rates compared to nonfrail patients (91.3% vs. 26.3%).

Study Design

Type

Cohort (n=1,826,285)

Multicenter

Yes

Structured PICO

Does frailty increase the risk of in-hospital mortality and nonhome discharge in patients over 65 years old undergoing surgery?

Population

1,826,285 surgical admissions for patients over 65 years old from the National Inpatient Sample (NIS) database between 2016 and 2018.

Intervention

Intermediate (score 5-15) or high (score >15) frailty risk as measured by the Hospital Frailty Risk Score (HFRS).

Comparator

Low frailty risk (HFRS < 5).

Outcome

In-hospital mortality.hard clinical

Frailty is strongly associated with increased in-hospital mortality and nonhome discharge across surgical subspecialties in older adults.

Main Result

Effect estimate: OR 24.58 (high risk) (95% CI 21.55-28.04)

Abstract

ABSTRACT Background and Aims Frailty is associated with adverse surgical outcomes in older adults, but it remains unknown if this association is consistent across all surgical specialties. This study aimed to evaluate the relationship between frailty and postoperative outcomes across surgical specialties using the National Inpatient Sample (NIS) database. Methods The NIS database between 2016 and 2018 was queried to analyze surgical admissions for patients over 65 years old. Frailty was assessed using the Hospital Frailty Risk Score (HFRS), categorizing patients into low ( 15) risk groups. Our primary outcome was in‐hospital mortality, and our secondary outcome was nonhome discharge. Multivariable logistic regression was performed to determine the association between frailty and our outcomes. Results Among 1,826,285 surgical admissions that met the inclusion criteria, 65.0% were classified as low frailty risk, 32.0% as intermediate risk, and 3.0% as high risk. Higher frailty scores were associated with increased in‐hospital mortality (intermediate risk: OR 9.61, 95% CI: 8.96–10.30; high risk: OR 24.58, 95% CI: 21.55–28.04) and higher odds of nonhome discharge (intermediate risk: OR 2.99, 95% CI: 2.94–3.04; high risk: OR 14.82, 95% CI: 13.64–16.10). Frail patients underwent emergent procedures at significantly higher rates than nonfrail patients (91.3% vs. 26.3%). In sensitivity analyses, frail patients consistently demonstrated increased levels of in‐hospital mortality and nonhome discharge across all surgical subspecialties. Conclusions Frailty, as measured by the HFRS, is strongly associated with increased in‐hospital mortality and nonhome discharge across surgical subspecialties, especially in emergent settings. Our study demonstrates the need to account for frailty to inform patient‐centered care and enhance surgical decision making.