Rheumatoid arthritis, frailty, and outcomes of surgical hospitalizations: A national population‐based analysis

OBJECTIVE: Hospitalization, particularly for surgery, represents a period of heightened stress. We evaluated how frailty attenuates the association of rheumatoid arthritis (RA) with negative health outcomes after elective non-cardiac surgery. METHODS: We conducted a cross-sectional study using the National Inpatient Sample (2018 to 2020), including adults (≥18 years) with elective hospitalizations with non-cardiac surgery. Frailty was measured using the Hospital Frailty Risk Score (HFRS). Surgeries were categorized by risk level. Outcomes included discharge health resources need (DHRN), composite adverse clinical events (CACE), and mortality. RESULTS: Among 8,800,359 hospitalizations (RA, 2.14%), 73.36% underwent intermediate risk surgery, 62.25% had HFRS > 0. DHRN occurred in 28.9%, CACE in 0.93%, all-cause mortality in 0.17%. Ten-point increase in HFRS was associated with 3.8-fold increased DHRN, 8.5-fold increased CACE, and 22.8-fold increased mortality. RA was not independently associated with CACE (adjusted Odds Ratio [aOR], 0.91; 95% CI, 0.82, 1.01; p=0.08), or mortality (aOR, 0.90; 95% CI, 0.71 to 1.15; p=0.41) but significantly associated with DHRN (aOR, 1.28, 1.25 to 1.31; p<0.001) after adjusting for confounders and frailty. In sensitivity analysis, RA had 10% higher relative odds of DHRN following orthopedic (aOR, 1.10; 95% CI, 1.07, 1.13; p<0.001) but not non-orthopedic intermediate risk surgery (aOR, 1.10; 95% CI, 0.98, 1.23; p=0.11). CONCLUSION: RA was associated with a higher odds of DHRN after orthopedic intermediate risk surgery but not CACE or inpatient mortality. Moreover, HFRS was associated with DHRN, CACE, and mortality. These findings underscore the need for disease-specific clinical considerations and highlight the potential utility of HFRS in discharge planning.