Correlation between frailty status and prolonged length of stay in the post-anesthesia care unit and development of a predictive model in elderly patients undergoing painless gastrointestinal endoscopy

Background The incidence of prolonged length of stay in the post-anesthesia care unit (PACU) is high among elderly patients undergoing painless gastrointestinal endoscopy, and the value of frailty assessment for perioperative risk stratification in this population remains unclear. Methods A total of 500 elderly patients undergoing outpatient painless gastrointestinal endoscopy were enrolled. Preoperative frailty was assessed using the Fried Frailty Phenotype, and perioperative clinical data were collected. Independent risk factors for prolonged PACU length of stay were identified through Logistic regression analysis, and a predictive model was constructed. Results Frailty severity showed a dose-dependent relationship with the incidence of intraoperative and postoperative adverse events and PACU length of stay. Multivariable analysis revealed that frailty was the strongest independent risk factor for prolonged PACU length of stay (OR = 4.278, 95%CI: 2.207-8.286, P < 0.001). The constructed multivariable predictive model had an area under the curve of 0.804, with a sensitivity of 82.4% and a specificity of 77.1%. Conclusions Frailty significantly increases the risk of prolonged PACU length of stay in elderly patients undergoing painless gastrointestinal endoscopy. The predictive model based on frailty status has favorable clinical application value.