Preoperative Frailty and Risk of Post-ERCP Pancreatitis in Older Adults with Choledocholithiasis.

<h4>Background</h4>Frailty is increasingly considered when evaluating surgical risk in older adults. However, evidence regarding whether frailty contributes to the risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in elderly patients is limited.<h4>Objective</h4>We aimed to evaluate whether preoperative frailty was associated with the development of post-ERCP pancreatitis (PEP) in elderly patients undergoing ERCP.<h4>Methods</h4>Patients aged 65 years or older who underwent ERCP for choledocholithiasis were retrospectively included. Frailty was assessed preoperatively using an electronic health record-based composite frailty index (EHR-CFI). PEP was defined according to the Cotton consensus criteria. Multivariable logistic regression, receiver operating characteristic (ROC) analysis, and net reclassification improvement (NRI) were used to explore the incremental contribution of frailty to PEP risk stratification.<h4>Results</h4>Among 696 patients, 79 (11.4%) developed PEP. After multivariable adjustment, frailty was associated with higher odds of PEP (OR = 2.09, 95% CI 1.08-4.05; P = 0.028). Adding frailty to a reference model containing difficult biliary cannulation (DBC), sex, age, and the Charlson Comorbidity Index (CCI) improved discrimination for PEP, with the AUC increasing from 0.714 to 0.755 (DeLong test P = 0.031). The NRI was 0.516 (95% CI 0.218-0.748), suggesting improved risk classification.<h4>Conclusion</h4>Preoperative frailty assessed using EHR-CFI was independently associated with PEP and may provide additional value for risk stratification in elderly patients with choledocholithiasis undergoing ERCP.