Frailty predicts increased costs in emergent general surgery patients: A prospective cohort cost analysis

Surgery. 2019 Jul;166(1):82-87. doi: 10.1016/j.surg.2019.01.033. Epub 2019 Apr 27.

Abstract

Background: Aging populations have led to increasing numbers of seniors presenting for emergency surgery. Older patients are at a higher risk of postoperative complications, prolonged hospitalization, and increased institutionalization. We hypothesized that increased frailty would be a risk factor for increased health care costs in elderly surgical patients who have undergone emergency abdominal surgery.

Methods: A prospective cost analysis of emergency general surgery patients 65 years of age and older was conducted. Demographic and clinical characteristics were obtained. Preadmission Clinical Frailty Scale score and Clavien-Dindo postoperative complications were collected. Patients were followed for 6 months after discharge. Hospitalization costs were calculated using the Alberta Health Services (AHS) microcosting database; other costs were obtained from Alberta Health Services and Alberta Health databases. The primary outcome was total insured cost (2016 Can$). Multivariate generalized linear regression of log-transformed costs was conducted.

Results: Overall, 321 patients were enrolled. Mean age was 76.1 years (standard deviation 7.8), median Clinical Frailty Scale was 3, mean length of stay was 15.9 days (standard deviation 23.4), and 48% suffered a complication. Median total insured cost was Can$18,021 and median total cost was Can$26,739. Multivariate analysis found American Society of Anesthesiologists score (adjusted ratio [AR] = 1.24, P = .001), CFS (AR = 1.27, P < .001), major complications (AR = 2.11, P < .001), and minor complications (AR = 1.48, P < .001) lead to increased total insured costs.

Conclusion: Costs increased-after adjusting for age, comorbidities, and preadmission function as frailty-and American Society of Anesthesiologists score increased if minor or major complications occurred. The detection of frailty represents an opportunity to target risk-reduction strategies and interventions to improve outcomes and decrease cost.

Trial registration: ClinicalTrials.gov NCT02233153.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Canada
  • Cohort Studies
  • Cost-Benefit Analysis / economics*
  • Emergency Treatment
  • Female
  • Frailty / mortality*
  • General Surgery / economics*
  • General Surgery / methods*
  • Geriatric Assessment
  • Humans
  • Length of Stay / economics*
  • Linear Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Postoperative Complications / economics
  • Postoperative Complications / physiopathology
  • Predictive Value of Tests
  • Prospective Studies
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT02233153