Identifying adults with serious illness in Singapore’s surgical population and its impact on postoperative healthcare utilisation and costs

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Introduction: Serious illness (SI) refers to life-limiting conditions that adversely affect quality of life. It is increasingly prevalent among ageing populations and has potential downstream repercussions for healthcare systems. Up to 40% of adults with SI undergo surgery, yet the burden of SI among adults undergoing surgery in Singapore remains poorly understood. In this study, the authors adapted a consensus-based definition of SI for the Singapore context and examined its association with postoperative healthcare utilisation and costs. Method: The authors used data from the registry of Singapore's largest healthcare cluster and included adults who underwent inpatient surgery between April 2019 and March 2023. First, they identified SI by mapping its consensus definition to locally adopted International Classification of Diseases, 10th Revision codes. Subsequently, they built multivariable regression models to test associations between SI and postoperative health-care utilisation and gross inpatient bill size. Results: Among 228,687 adults who underwent inpatient surgery, 41,011 (17.9%) met the adapted SI definition. Compared with adults without SI, adults with SI had a longer length of stay (incidence rate ratio 1.81; 95% confidence interval [CI] 1.80-1.83), higher odds of 30-day hospital readmission (odds ratio [OR] 1.58; 95% CI 1.52-1.64), 1-year hospital readmission (OR 2.60; 95% CI 2.53-2.67), 30-day emergency department (ED) visits (OR 1.57; 95% CI 1.51-1.64), 1-year ED visits (OR 2.08; 95% CI 2.03-2.14), and higher relative bill size (relative ratio 1.64; 95% CI 1.62-1.67). Conclusion: SI was associated with greater postoperative healthcare utilisation and higher gross inpatient bill size. The findings highlight the burden of SI in Singapore and the need for targeted interventions in this vulnerable population to decrease downstream adverse effects on Singapore's healthcare system.