Key result
Preoperative frailty in older adults undergoing major elective noncardiac surgery was associated with a 1.53-fold increase in total health system costs (95% CI 1.51-1.56) in the year after surgery.
Why the study?
Patients with frailty experience higher rates of perioperative morbidity and mortality, but healthcare costs attributable to frailty remain poorly defined.
Does preoperative frailty increase total health system costs in older patients undergoing major, elective noncardiac surgery?
Cohort (n=171,576)
Does preoperative frailty increase total health system costs in older patients undergoing major, elective noncardiac surgery?
Effect estimate: ratio of means 1.53 (95% CI 1.51-1.56)
Preoperative frailty is associated with a 1.5-fold increase in total health system costs in the year following major, elective noncardiac surgery.
Frailty may drive substantial post-surgical costs in older adults; leaves open whether mitigation strategies reduce expenditures.
BACKGROUND: Patients with frailty consistently experience higher rates of perioperative morbidity and mortality; however, costs attributable to frailty remain poorly defined. This study sought to identify older patients with and without frailty using a validated, multidimensional frailty index and estimated the attributable costs in the year after major, elective noncardiac surgery. METHODS: The authors conducted a retrospective population-based cohort study of all patients 66 yr or older having major, elective noncardiac surgery between April 1, 2012, and March 31, 2018, using linked health data obtained from an independent research institute (ICES) in Ontario, Canada. All data were collected using standard methods from the date of surgery to the end of 1-yr follow-up. The presence or absence of preoperative frailty was determined using a multidimensional frailty index. The primary outcome was total health system costs in the year after surgery using a validated patient-level costing method capturing direct and indirect costs. Secondary outcomes included costs to postoperative days 30 and 90 along with sensitivity analyses and evaluation of effect modifiers. RESULTS: Of 171,576 patients, 23,219 (13.5%) were identified with preoperative frailty. Unadjusted costs were higher among patients with frailty (ratio of means 1.79, 95% CI 1.76 to 1.83). After adjusting for confounders, an absolute cost increase of $11,828 Canadian dollar (ratio of means 1.53; 95% CI, 1.51 to 1.56) was attributable to frailty. This association was attenuated with additional control for comorbidities (ratio of means 1.24, 95% CI, 1.22 to 1.26). Among contributors to total costs, frailty was most strongly associated with increased postacute care costs. CONCLUSIONS: For patients with preoperative frailty having elective surgery, the authors estimate that attributable costs are increased 1.5-fold in the year after major, elective noncardiac surgery. These data inform resource allocation for patients with frailty.
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McGinn et al. (2023) conducted a cohort in major, elective noncardiac surgery (n=171,576). Preoperative frailty vs. Absence of preoperative frailty was evaluated on total health system costs in the year after surgery (ratio of means 1.53, 95% CI 1.51-1.56). Preoperative frailty in older adults undergoing major elective noncardiac surgery was associated with a 1.53-fold increase in total health system costs (95% CI 1.51-1.56) in the year after surgery.
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