Preoperative frailty was associated with higher long-term health care utilization after surgery, including increased inpatient admissions for frail patients (HR 1.75; 95% CI 1.70-1.79).
Cohort (n=183,343)
Yes
Does preoperative frailty increase long-term health care utilization in patients undergoing elective general and vascular surgery?
Preoperative frailty is strongly associated with increased long-term health care utilization, including inpatient admissions and nursing home encounters, up to 24 months after elective general and vascular surgery.
Hazard Ratio: 1.75 (95% CI 1.7–1.79)
Importance: Surgical quality improvement efforts have largely focused on 30-day outcomes, such as readmissions and complications. Surgery may have a sustained impact on the health and quality of life of patients considered frail, yet data are lacking on the long-term health care utilization of patients with frailty following surgery. Objective: To examine the independent association of preoperative frailty on long-term health care utilization (up to 24 months) following surgery. Design, Setting, and Participants: This retrospective, observational cohort study included patients undergoing elective general and vascular surgery performed in the Veterans Affairs (VA) Surgical Quality Improvement Program with study entry from October 1, 2013, to September 30, 2018. Patients were followed up for 24 months. Patients with nursing home visits prior to surgery, emergent cases, and in-hospital deaths were excluded. Data analysis was conducted from September 2022 to May 2024. Exposures: Preoperative frailty as assessed by the Risk Analysis Index (RAI-A) score: robust, less than 20; normal, 20 to 29; frail, 30 to 39; and very frail, 40 or more. Main Outcomes and Measures: The primary outcome was health care utilization through 24 months, defined as inpatient admissions, outpatient visits, emergency department (ED) visits, and nursing home or rehabilitation services collected via Corporate Data Warehouse and Centers for Medicare 12 915 females 7.0%; 28 671 Black patients 16.0; 138 323 White patients 77.3%; 94 451 Medicare enrollees 51.5%) with mean (SD) RAI-A score of 22.2 (7.0). After adjustment for baseline characteristics and preoperative use of health care services, frailty was associated with higher inpatient admissions (frail: hazard ratio HR, 1.75; 95% CI, 1.70-1.79; very frail: HR, 2.33; 95% CI, 2.25-2.42), ED visits (frail: HR, 1.39; 95% CI, 1.36-1.41; very frail: HR, 1.70; 95% CI, 1.65-1.75), and nursing home or rehabilitation encounters (frail: HR, 4.97; 95% CI, 4.36-5.67; very frail: HR, 7.44; 95% CI, 6.34-8.73). For patients considered frail and very frail, health care utilization was higher after surgery and remained significant through 24 months for all outcomes (using piecewise Cox proportional hazards modeling). Conclusions and Relevance: In this study, frailty was a significant risk factor for high long-term health care utilization after surgery. This may have quality of life implications for patients and policy implications for health care systems and payers.
Dossabhoy et al. (2024) conducted a cohort in Elective general and vascular surgery (n=183,343). Preoperative frailty vs. Robust or normal patients was evaluated on Health care utilization through 24 months (inpatient admissions, outpatient visits, ED visits, nursing home or rehabilitation services) (HR 1.75, 95% CI 1.70-1.79). Preoperative frailty was associated with higher long-term health care utilization after surgery, including increased inpatient admissions for frail patients (HR 1.75; 95% CI 1.70-1.79).