P1049 - Development and Validation of Endoscopic Ultrasound (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP)-Specific Frailty Risk Score

Amlish Gondal, MD¹, Subash Ghimire, MD¹, Sohaib Shabih, MD¹, Rasmita Budhathoki, MD¹, Tsu Jung Yang, MD¹, Vivian Deng, MS², Noah West, MS², Madeline Mylod, MS², Conor Banta, MS³, Daebin Im, MD, MPH¹, Michael Georgetson, MD¹, Thomas McDonald, MD^1
1Guthrie Robert Packer Hospital, Sayre, PA; ²Lake Erie College of Osteopathic Medicine, Sayre, PA; ³Geisinger Commonwealth School of Medicine, Scranton, PA

Introduction: Risk stratification for ERCP remains an area of evolving literature. Emerging observational data indicates worse outcomes in frail patients after ERCP. This study aims to develop an ERCP and EUS specific frailty risk score (ERCP-EUS FS) using a comorbidity index approach to measuring frailty and tests its predictive performance.

Methods: Demographic, procedure and outcome related data were collected retrospectively for the previous 10 years at a single institution in the US. Half of the collected sample size was randomly distributed into a risk score development cohort and the half were assigned to the validation cohort. A multivariate logistic regression analysis on development cohort was conducted using SPSS. A frailty score was assigned to each significant risk factor by rounding off ß-coefficients to the nearest whole number from initial multivariable analysis. Event rates of 30-day major adverse events (defined as composite of mortality, perforation, post ERCP pancreatitis, pneumonia, ICU admission or cardiac arrest) were studied in the validation cohort using the frail risk score. ROC analysis and c-statistic analysis was conducted to assess discriminatory capacity of ERCP and EUS frailty score for outcome of interest in the validation cohort. P values of less than 0.05 were used for statistical significance in regression models.

Results: Out of 6663 patients that underwent ERCP, 3332 were assigned to frailty score development cohort while the rest were assigned to validation cohort. Baseline characteristics of both cohorts were similar (p >0.05 for age, gender, race, and comorbidities). A frailty score consisting of history of smoking, DVT, COPD, CAD, CAD was generated (Table 1). The risk of major adverse events increased with increasing frailty risk for in the validation cohort (Figure 1). ROC analysis yielded a C statistic of 0.705 (confidence interval 0.68-0.72, P< 0.05).

Discussion: A predictable increase in 30-day adverse outcomes is seen with an increasing frailty score on ERCP-EUS FS. Recent data utilizing Hospital Frailty Index on national databases is showing similar trends. Current novel frailty score is developed specifically in patients undergoing ERCP-EUS as opposed to previously utilized hospital frailty index which was developed in non-ERCP-EUS populations and then extrapolated. Predictive capacity of current frailty score was also indicating the strength of this model. Incorporation of frailty into risk stratification for ERCP is recommended.



Disclosures:


Amlish Gondal, MD¹, Subash Ghimire, MD¹, Sohaib Shabih, MD¹, Rasmita Budhathoki, MD¹, Tsu Jung Yang, MD¹, Vivian Deng, MS², Noah West, MS², Madeline Mylod, MS², Conor Banta, MS³, Daebin Im, MD, MPH¹, Michael Georgetson, MD¹, Thomas McDonald, MD¹. P1049 - Development and Validation of Endoscopic Ultrasound (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP)-Specific Frailty Risk Score, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.