Comparing Hospital-Free Days by Frailty Status for Patients Undergoing Surgical Intervention for Cardiovascular Disease

BACKGROUND: Aging patients face increasing comorbid conditions, most commonly atherosclerotic cardiovascular diseases, which are often treated surgically; however, aging is also associated with frailty, which portends adverse postoperative outcomes. Assessing outcomes in a frail surgical cohort necessitates the use of valid patient-centered metrics such as hospital-free days (HFDs) quantifying patient time at home and out of the hospital. STUDY DESIGN: We included patients from the Florida State Inpatient Database undergoing coronary artery bypass grafting, carotid endarterectomy, or abdominal aortic aneurysm repair (2015 to 2018). The association between frailty (Risk Analysis Index) and 90-day HFD (HFD-90) was assessed using multivariable zero-inflated negative binomial and ordinal logistic regression models. Logistic regression evaluated the association between frailty and in-hospital mortality. RESULTS: Overall, 67,861 patients (age 69.3 ± 9.9 years; 28.3% women; 46.4% robust, 46.6% normal, and 7.0% frail) were included from 148 Florida hospitals. Median HFD-90 was 83 (interquartile range 79 to 86) days, and 2.6% of patients experienced in-hospital mortality. Compared with normal status, robust status was associated with higher HFD-90 (adjusted rate ratio 1.03, 95% CI 1.02 to 1.04), whereas frailty was associated with lower HFD-90 (adjusted rate ratio 0.95, 95% CI 0.94 to 0.96) risk. Similarly, robust patients had lower adjusted odds of in-hospital mortality (adjusted odds ratio 0.40, 95% CI 0.34 to 0.48), whereas frail patients had higher odds (adjusted odds ratio 6.20, 95% CI 4.90 to 7.77) as compared with normal. CONCLUSIONS: HFD-90 is a feasible, comprehensive, patient-centered metric to assess outcomes in frail patients which encompasses the most used postoperative outcomes assessment tools (mortality, length of stay, and readmission) into 1 inclusive measure.