The Economic and Dispositional Burden of Frailty in DLBCL Patients Undergoing Inpatient Chemotherapy: A 5-Year National Analysis
Frailty has been increasingly recognized as an important predictor of clinical outcome and economic burden on patients with malignancies. As 40% of patients with Diffuse Large B-Cell Lymphoma (DLBCL) are elderly, studies on the treatment tolerance and physiological reserve are highly relevant. However, national-level data evaluating the economic and hospital burden associated with frailty among DLBCL patients undergoing inpatient chemotherapy remain limited. Our Objective is to evaluate the impact of frailty on hospital outcomes, healthcare utilization, and economic burden among patients with DLBCL receiving inpatient chemotherapy in the United States over five years.
Materials and Methods/Case Presentation/Objective: This is a retrospective analysis using the National Inpatient Sample (NIS), 2016-2020. All adult hospitalizations with DLBCL were identified within ICD 10-CM code. Patients admitted for chemotherapy agent administration were identified. Hospital Frailty Risk Score (HFRS) was used to categorize Low, intermediate, and high frail patients. The primary outcome for our study was in-hospital mortality; secondary outcomes were measured as length of stay, total hospital charges, and dispositional burden, which was evaluated with non-home discharge among surviving patients.
Results/Description/Main Outcome Measure(s):
72832 DLBCL admissions were identified among all the hospitalizations from 2016 to 2020. Admission associated with inpatient chemotherapy was 33432 unweighted admissions, corresponding to 166055 weighted hospitalizations. Frailty distribution in the treated cohort was 74.9% low risk, 24.0% intermediate risk, and 1.1% high risk. Frailty showed a graded increase in association with mortality in survey-weighted models. Frailty was associated with higher resource utilization, with LOS of 5.38 days for low frailty, 13.15 days in intermediate frailty, and 27.98 days in the high frailty group. Frailty was associated with elevated burden among survivors for non-home discharge. Adjusted predicted non-home discharge probability rose stepwise from 15.9% (low frailty) to 30.6% (intermediate frailty) and 62.3% (high frailty).
Conclusion(s).: Frailty in DLBCL hospitalizations receiving inpatient systemic therapy has a significant and graded association with higher mortality in the hospital, longer stay, greater hospital charges, and substantially higher non-home discharge in those who survived. Our study showed that frailty, clinically meaningful risk stratification beyond chronological age, should be incorporated in oncologic decision making during hospitalization, for appropriate treatment strategy, resource planning, and discharge preparations.
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