# Frailty, Comorbidities, and In-Hospital Outcomes in Older Cholangiocarcinoma Patients

## TL;DR

Frailty, not just comorbidities, strongly predicts worse outcomes in older patients hospitalized with cholangiocarcinoma.

## Contribution

This study highlights the distinct impact of frailty on in-hospital outcomes in older cholangiocarcinoma patients.

## Key findings

- High frailty is linked to an eight-fold higher mortality risk in older CCA patients.
- Frail patients had a 70% longer hospital stay and 52% higher charges compared to less frail patients.
- Comorbidity scores did not significantly affect in-hospital outcomes.

## Abstract

Introduction: Frailty is increasingly recognized as a critical predictor of adverse outcomes in older adults, particularly those with cancer. However, the role of frailty—distinct from comorbidity burden—has not been fully characterized in older adults hospitalized with cholangiocarcinoma (CCA), a rare but aggressive malignancy with rising incidence in the aging population. Methodology: A retrospective cross-sectional analysis of the Nationwide Inpatient Sample (NIS) 2019–2022 was performed. Adult inpatients aged ≥ 65 with CCA-related ICD-10 codes were identified. Patients were stratified into frailty categories based on the Hospital Frailty Risk Score (HFRS). Multivariable regression models were used to assess associations with in-hospital mortality, length of stay (LOS), and hospital charges. Results: Among 18,785 hospitalizations, the in-hospital mortality rate was 7.18%. High frailty conferred an eight-fold increased risk of mortality, a 70% longer LOS, and 52% higher charges compared to low frailty. Elixhauser comorbidity scores were not significantly associated with outcomes. Discussion: These findings support the use of frailty screening to guide inpatient care planning and optimize outcomes in older adults with CCA.