Key result
Elective surgery is associated with predictable shifts to high healthcare utilization in ~6% of patients.
Why the study?
Evidence was comparatively lacking for the longer-term effects of preoperative frailty on postoperative health care utilization.
Does preoperative frailty predict trajectories of health care utilization before and after elective surgery in adult patients?
Cohort (n=29,067)
Does preoperative frailty predict trajectories of health care utilization before and after elective surgery in adult patients?
Surgery occasions a transition from low to high health care utilization for a substantial subgroup of patients, which can be predicted using multivariable modeling of preoperative characteristics.
Preoperative models may flag patients for sustained high utilization after elective surgery; hypothesis-generating for frailty-targeted interventions.
OBJECTIVE: To characterize patterns of health care utilization before and after surgery and determine any association with preoperative frailty. BACKGROUND: Frail patients experience worse postoperative outcomes and increased costs during the surgical encounter. Evidence is comparatively lacking for the longer-term effects of frailty on postoperative health care utilization. METHODS: Retrospective, longitudinal cohort analysis of adult patients undergoing any elective surgical procedure after preoperative frailty assessment with the Risk Analysis Index from February 2016 to December 2020 at a large integrated health care delivery and financing system. Group-based trajectory modeling of claims data estimated distinct clusters of patients with discrete utilization trajectories. Multivariable regression predicted membership in trajectories of interest using preoperative characteristics, including frailty. RESULTS: Among 29,067 surgical encounters, 4 distinct utilization trajectories emerged in longitudinal data from the 12 months before and after surgery. All cases exhibited a surge in utilization during the surgical month, after which most patients returned to "low" [25,473 (87.6%)], "medium" [1403 (4.8%)], or "high" [528 (1.8%)] baseline utilization states established before surgery. The fourth trajectory identified 1663 (5.7%) cases where surgery occasioned a transition from "low" utilization before surgery to "high" utilization afterward. Risk Analysis Index score alone did not effectively predict membership in this transition group, but a multivariable model with other preoperative variables was effective ( c = 0.859, max rescaled R2 = 0.264). CONCLUSIONS: Surgery occasions the transition from low to high health care utilization for a substantial subgroup of surgical patients. Multivariable modeling may effectively discriminate this utilization trajectory, suggesting an opportunity to tailor care processes for these patients.
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Tarnasky et al. (2023) conducted a cohort in Elective surgical procedure (n=29,067). Elective surgery was evaluated on Health care utilization trajectories. Elective surgery occasioned a transition from low to high health care utilization in 5.7% of patients, which was effectively predicted by a multivariable model (c=0.859).