What does this research mean for the field?

Cumulative multi-domain frailty burden is associated with a stepwise increase in the risk of inpatient mortality, acute care escalation, length of stay, and hospitalization cost among hospitalized patients with solid tumors. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research examines how multi-domain frailty impacts outcomes for hospitalized patients with solid tumors.

May 30, 2026

Frailty phenotypes and acute care escalation in hospitalized patients with solid tumors: A National Inpatient Sample analysis, 2016–2023.

Key Points

This research examines how multi-domain frailty impacts outcomes for hospitalized patients with solid tumors.
Survey-weighted analysis of the National Inpatient Sample from 2016 to 2023.
Included adult hospitalizations for solid tumor malignancies while excluding specific subtypes and palliative care.
Outcomes measured include in-hospital mortality, airway escalation, length of stay, and hospitalization cost.
Unadjusted mortality increased from 2.02% to 9.81% with increased frailty burden.
Adjusted odds ratios indicated strong associations between frailty burden and mortality, with ≥3 domains showing aOR 4.18.
Airway escalation rates rose from 2.60% to 11.50% as frailty burden increased.

Abstract

e23202 Background: Frailty-aware oncology is increasingly emphasized, yet inpatient frailty is inconsistently captured and often reduced to single markers. Whether cumulative multi-domain frailty burden predicts inpatient outcomes among hospitalized patients with solid tumors remains unclear. Methods: A survey-weighted analysis of the National Inpatient Sample (NIS), 2016–2023, was performed. Adult hospitalizations with solid tumor malignancies (ICD-10-CM C00–C80) were included. Hematologic malignancies (C81–C96) and palliative care encounters (Z51. 5) were excluded. Frailty proxies included malnutrition (E43/E44/E46), cachexia or weight loss (R64), sarcopenia (M62. 84), dysphagia (R13*), and pressure ulcer (L89*). Frailty burden was categorized as 0, 1, 2, or ≥3 domains. The primary outcome was in-hospital mortality. Secondary outcomes included any airway escalation (mechanical ventilation or tracheostomy), shock (R57*), length of stay (LOS), and hospitalization cost. Survey-weighted multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs). LOS and cost were modeled using survey-weighted linear and gamma regression. Results: Among 3, 046, 500 unweighted solid tumor hospitalizations (weighted subpopulation size 15, 232, 496), frailty burden distribution was: 0 domains 79. 46% (95% CI 79. 32–79. 61), 1 domain 16. 46% (95% CI 16. 34–16. 57), 2 domains 3. 61% (95% CI 3. 57–3. 65), and ≥3 domains 0. 48% (95% CI 0. 47–0. 49). Unadjusted mortality increased stepwise with frailty burden from 2. 02% (95% CI 1. 99–2. 05) to 9. 81% (95% CI 9. 31–10. 33), and airway escalation from 2. 60% (95% CI 2. 57–2. 63) to 11. 50% (95% CI 10. 98–12. 05). LOS increased from 5. 00 days (95% CI 4. 99–5. 02) to 11. 52 days (95% CI 11. 29–11. 75), and mean cost from 20, 943. 82 (95% CI 20, 532. 55–21, 355. 09) to 35, 440. 96 (95% CI 34, 009. 64–36, 872. 28). After adjustment, frailty burden remained strongly associated with mortality (1 domain aOR 2. 08, 95% CI 2. 04–2. 12; 2 domains aOR 3. 14, 95% CI 3. 04–3. 25; ≥3 domains aOR 4. 18, 95% CI 3. 91–4. 47) and airway escalation (1 domain aOR 2. 58, 95% CI 2. 53–2. 63; 2 domains aOR 3. 77, 95% CI 3. 66–3. 88; ≥3 domains aOR 4. 69, 95% CI 4. 41–4. 98). In phenotype-specific models, malnutrition (aOR 1. 86, 95% CI 1. 82–1. 90) and pressure ulcer (aOR 2. 25, 95% CI 2. 17–2. 34) were the strongest predictors of mortality, while dysphagia was most strongly associated with airway escalation (aOR 2. 98, 95% CI 2. 91–3. 06). Conclusions: In nationally representative solid tumor hospitalizations, cumulative multi-domain frailty burden identifies stepwise risk for inpatient mortality, acute care escalation, LOS, and cost. Frailty phenotyping using routinely coded inpatient markers may support earlier multidisciplinary assessment and inform risk-adjusted inpatient oncology care pathways.

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