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Introduction: Frailty is thought to be associated with an increased risk of adverse health outcomes such as death and falls, but comparatively little is known about the impact of frailty transitions on the adverse health outcomes. Moreover, owing to insufficient sample size or a single-center study design, previous studies have not been sufficiently representative of elderly inpatients in China. This study aimed to provide estimates at the population level of the association between frailty transitions and adverse outcomes among elderly inpatients following discharge. Methods: This was a large-scale multicenter cohort study conducted from October 2018 to February 2021. The FRAIL scale was used to estimate frailty status. Frailty transitions were derived by considering frailty status at baseline and the 3-month follow-up, which encompassed five patterns: persistent non-frailty, persistent pre-frailty, persistent frailty, improvement in frailty, and worsening of frailty. The outcome variables included mortality, falls, hospital readmissions, and Health-Related Quality of Life (HRQoL). Cox proportional hazard regression, generalized linear models and linear regression was used to examine the association between frailty transitions and adverse health outcomes. Results: A total of 8,256 patients were included in the study, 40.70% of study participants were non-frail, 43.04% were pre-frail, and 16.27% were frail. Compared with patients who persistently non-frail patients, those who frailty improvement, persistent pre-frailty, worsening frailty, and persistent frailty showcased escalated risks of mortality within 2 years after enrollment [HR (95% CI): 1.32 (1.06–1.64)], 1.71 (1.37–2.13), 2.43 (1.95–3.02), and 2.44 (1.81–3.29), respectively. These groups also faced elevated hazards of 2-year falls [OR(95% CI): 1.586(1.13–2.23), 2.21(1.55–3.15), 1.94(1.33–2.82), 2.71(1.59–4.62)] and re-hospitalization risk within 2 years[OR(95% CI): 1.33(1.13–1.56), 1.56(1.32–1.86), 1.53(1.28–1.83), 2.29(1.74–3.01). The number of falls increased by 0.76 over 2 years in frailty-worsened patients and 0.81 in persistently pre-frail patients. The total days of rehospitalization increased by 0.35 over 2 years in frailty-improved patients, by 0.61 in frailty-worsened patients, by 0.66 in elderly in persistently pre-frail patients and by 0.80 in persistently frail patients. Moreover, patients exhibiting frailty-improved [-1.23 (95% CI: -2.12 to -0.35)], persistently pre-frail[-4.95 (95% CI: -5.96 to -3.94)], frailty-worsened [-3.67 (95% CI: -4.71 to -2.62)], and persistently frail [-9.76 (95% CI: -11.60 to -7.93)] displayed inverse correlations with the regression coefficients of HRQoL. Discussion: Frailty-improved, worsened, persistently pre-frail, and frail inpatients face higher risks of mortality, falls, rehospitalization, reduced HRQoL than consistently non-frail inpatients. Screening for frailty among elderly inpatients can identify individuals at increased risk of adverse health outcomes. [ABSTRACT FROM AUTHOR]

Aims and Objectives: (i) To estimate the national incidence of unplanned removal of peripherally inserted central catheters (PICCs) in China. (ii) To explore the associated risk factors to provide evidence for the prevention. Design: A multi‐centre prospective cohort study. Methods: A representative sample of 3222 Chinese adult patients with successful PICC insertion was recruited for the PICC Safety Management Research (PATH) using a two‐stage cluster sampling method from December 2020 to June 2022. Sixty hospitals from seven Chinese provinces representing all geographical regions were selected. Demographic information and PICC characteristics were collected using a standard online case report form. Risk factors for the unplanned removal of PICCs were assessed using a cause‐specific hazard model and verified using a sub‐distribution hazard model. STROBE guidelines were followed in reporting this study. Results: Three thousand one hundred and sixty‐six patients were included in the final analysis with a mean age of 59 years and a total of 344,247 catheter days. The incidence of unplanned removal was 10.04%. Female, with thrombosis history, PICC insertion due to infusion failure, valved catheter and double‐lumen catheter were risk factors, whereas longer insertion and exposure length were protective factors in the cause‐specific hazard model. Higher BMI became an independent risk factor in the sub‐distribution hazard model. Conclusions: Unplanned removal of PICCs is a serious clinical challenge in China. Our findings call for prevention strategies targeting the identified risk factors. Relevance to Clinical Practice: Our study characterised the epidemiology of unplanned removal of PICCs among Chinese adult inpatients, highlighting the need for prevention among this population and providing a basis for the formulation of relevant prevention strategies. Patient or Public Contribution: Patients contributed through sharing their information required for the case report form. Healthcare professionals who provide direct care to the patient at each medical centre contributed by completing the online case report form. [ABSTRACT FROM AUTHOR]