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Cumulative insurance charges after major surgical procedures indicate frail patients use significantly more inpatient medical and postacute services compared to robust or normal counterparts
Silver, D. S., Bilderback, A. L., Ludwig, J. M., Kinsky, S. M., Helwig, A., Schuster, J., & Hall, D. E. (2021). The cost of surgical frailty: Cumulative insurance charges after major surgical procedures indicate frail patients use significantly more inpatient medical and postacute services compared to robust or normal counterparts. Journal of the American College of Surgeons, 233(5), S132-S133. Advance online publication. https://doi.org/10.1016/j.jamcollsurg.2021.07.257
Introduction: Frailty in surgical patients is associated with increased morbidity, mortality, and costs. However, little is known about the impact of frailty on post-acute health care use. Methods: Frailty was assessed preoperatively using the Risk Analysis Index (RAI) in a multispecialty sample of elective surgical patients. For patients insured by the health system’s integrated insurance plan, charges for the year following the initial visit were quantified to measure utilization. Charges were stratified by category of service. Patients were stratified by RAI score as robust, normal, frail, or very frail, scaling charges to the normal group. Results: The study included 91,232 patients from February 2016 to January 2020. The mean age was 54.3 (16.4) with 42% male and 85.9% white. Specialties represented include Orthopaedics (23.7%), Otolaryngology (16.9%), Urology (13.5%), and General Surgery (8.1%). Compared to patients with normal RAI values, total charges for frail and very frail patients were 4% and 17% higher, respectively, and the robust group was 40% lower. Whereas inpatient surgical charges were similar across groups, the premium (or discount) associated with frailty was primarily due to increased use of post-acute (eg nursing homes) and inpatient medical services, which were 194% and 120% higher for the frail, and 293% and 166% higher for the very frail. Conclusion: These findings demonstrate that frailty incurs increased postoperative charges for both post-acute and inpatient medical services. These data may inform clinical and reimbursement strategies aimed at ensuring high value health care by mitigating the risks of surgery and managing its costs.