Claims-based frailty and short-term adverse events after esophageal or gastric endoscopic submucosal dissection in older adults

BACKGROUND: Risk stratification before esophageal and gastric endoscopic submucosal dissection (ESD) in older adults often relies on age and comorbidity; however, these measures may not capture vulnerability reflected in routinely collected claims data. We aimed to evaluate the claims-based frailty and short-term adverse events association after esophageal and gastric endoscopic submucosal dissection. METHODS: We used a nationwide Japanese administrative database to identify patients aged ≥ 75 years who underwent first esophageal or gastric ESD. Frailty was defined using the Hospital Frailty Risk Score (HFRS), calculated from diagnoses during a 2 year lookback period. After 1:1 propensity score matching, frail and non-frail patients were compared. The primary outcome was binary composite of short-term adverse events, including in-hospital perforation/peritonitis, delayed bleeding, thromboembolism, aspiration pneumonia, and 30 day all-cause mortality. Component outcomes, survival, length of stay, costs, and readmission were also evaluated. RESULTS: Among 15,184 eligible patients, 4,970 matched pairs were included. Frailty was associated with the composite adverse outcome (adjusted odds ratio 1.35; 95% confidence interval 1.19-1.53), driven mainly by perforation/peritonitis and delayed bleeding. No significant differences were observed for 30 day mortality, thromboembolic events, or aspiration pneumonia. Frailty was also associated with lower overall survival during follow-up, whereas median length of stay was identical between groups. CONCLUSION: Among older adults undergoing esophageal or gastric ESD, HFRS-defined claims-based frailty was associated with higher rates of short-term adverse events, particularly perforation/peritonitis and delayed bleeding. These findings suggest that routinely collected claims data may help identify vulnerable patients who warrant closer peri-procedural assessment and monitoring.