Outcomes of frailty among hospitalized patients with acute myeloid leukemia: A National Inpatient Sample analysis (2017–2022).

Abstract

e18520 Background: Frailty is increasingly recognized as an important determinant of outcomes in patients with hematologic malignancies. However, population-level data evaluating the burden of frailty and its impact on inpatient outcomes among patients hospitalized with acute myeloid leukemia (AML) remain limited. We aimed to assess the prevalence of frailty and its association with in-hospital mortality and healthcare utilization among hospitalized AML patients in the United States. Methods: We conducted a retrospective study using the National Inpatient Sample (NIS) from 2017 to 2022. Adult hospitalizations with a diagnosis of AML were identified using ICD-10 codes. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator. Multivariate and univariate survey-adjusted regressions were employed to assess the association between frailty and in-hospital mortality, length of stay (LOS), and total hospital charges. Year-stratified analyses were conducted to evaluate temporal trends. Results: Among an estimated 376,755 hospitalized patients with AML nationwide, 17.5% (95% CI 17.1–17.9%) met criteria for frailty. The mean age of frail patients was 63.5 years, compared to 58.8 years in non-frail patients, with a male predominance. Frailty prevalence varied significantly by race, with higher proportions observed among Black patients and lower proportions among Hispanic patients (p<0.001). Patients with frailty had significantly higher odds of in-hospital mortality compared with non-frail patients (OR 2.12, 95% CI 2.00–2.26; p<0.001). Frail patients experienced longer hospitalizations, with a mean increase of 6.0 days (95% CI 5.6–6.4; p <0.001), and substantially higher healthcare utilization, incurring $104,391 more in total hospital charges per admission (95% CI $94,783–$113,998; p <0.001). These associations were consistent across all study years (2017–2022), with frailty conferring an approximately twofold increase in mortality risk annually. Conclusions: Frailty is present in nearly one in six hospitalized patients with AML and is linked to higher in-hospital mortality, longer hospital stays, and substantially increased healthcare costs. Baseline functional impairment and geriatric syndromes increase vulnerability to infections, treatment-related complications, and delayed recovery, likely explaining our observed findings and highlighting the need for systematic frailty assessment and targeted interventions to improve outcomes in this vulnerable population.