Frailty Cost: Economic Impact of Frailty in the Elective Surgical Patient

Wilkes, Justin G.; Evans, Jessica L.; Prato, B. Stephen; Hess, Steven A.; MacGillivray, Dougald C.; Fitzgerald, Timothy L.

doi:10.1016/j.jamcollsurg.2019.01.015

Cited by 52 publications

(48 citation statements)

References 45 publications

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“…More importantly, it has recently been shown that frailty, independent of age, leads to increased economic burden in elective surgery. 42 With the continuing aging of the population, especially in those 65 years of age and older, the specialty of neurosurgery will be increasingly challenged by the associated growth in surgical procedures. Etzioni and colleagues had forecasted a growth in procedure-based work in neurosurgery of 15% by 2010 and 28% by 2020 in their study in 2003.…”

Section: Need For Pac After Elective Craniotomy In Elderly Patientsmentioning

confidence: 99%

How safe are elective craniotomies in elderly patients in neurosurgery today? A prospective cohort study of 1452 consecutive cases

Schär

Tashi

Branca

et al. 2021

Journal of Neurosurgery

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OBJECTIVEWith global aging, elective craniotomies are increasingly being performed in elderly patients. There is a paucity of prospective studies evaluating the impact of these procedures on the geriatric population. The goal of this study was to assess the safety of elective craniotomies for elderly patients in modern neurosurgery.METHODSFor this cohort study, adult patients, who underwent elective craniotomies between November 1, 2011, and October 31, 2018, were allocated to 3 age groups (group 1, < 65 years [n = 1008], group 2, ≥ 65 to < 75 [n = 315], and group 3, ≥ 75 [n = 129]). Primary outcome was the 30-day mortality after craniotomy. Secondary outcomes included rate of delayed extubation (> 1 hour), need for emergency head CT scan and reoperation within 48 hours after surgery, length of postoperative intensive or intermediate care unit stay, hospital length of stay (LOS), and rate of discharge to home. Adjustment for American Society of Anesthesiologists Physical Status (ASA PS) class, estimated blood loss, and duration of surgery were analyzed as a comparison using multiple logistic regression. For significant differences a post hoc analysis was performed.RESULTSIn total, 1452 patients (mean age 55.4 ± 14.7 years) were included. The overall mortality rate was 0.55% (n = 8), with no significant differences between groups (group 1: 0.5% [95% binominal CI 0.2%, 1.2%]; group 2: 0.3% [95% binominal CI 0.0%, 1.7%]; group 3: 1.6% [95% binominal CI 0.2%, 5.5%]). Deceased patients had a significantly higher ASA PS class (2.88 ± 0.35 vs 2.42 ± 0.62; difference 0.46 [95% CI 0.03, 0.89]; p = 0.036) and increased estimated blood loss (1444 ± 1973 ml vs 436 ± 545 ml [95% CI 618, 1398]; p <0.001). Significant differences were found in the rate of postoperative head CT scans (group 1: 6.65% [n = 67], group 2: 7.30% [n = 23], group 3: 15.50% [n = 20]; p = 0.006), LOS (group 1: median 5 days [IQR 4; 7 days], group 2: 5 days [IQR 4; 7 days], and group 3: 7 days [5; 9 days]; p = 0.001), and rate of discharge to home (group 1: 79.0% [n = 796], group 2: 72.0% [n = 227], and group 3: 44.2% [n = 57]; p < 0.001).CONCLUSIONSMortality following elective craniotomy was low in all age groups. Today, elective craniotomy for well-selected patients is safe, and for elderly patients, too. Elderly patients are more dependent on discharge to other hospitals and postacute care facilities after elective craniotomy.Clinical trial registration no.: NCT01987648 (clinicaltrials.gov).

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Section: Need For Pac After Elective Craniotomy In Elderly Patientsmentioning

confidence: 99%

How safe are elective craniotomies in elderly patients in neurosurgery today? A prospective cohort study of 1452 consecutive cases

Schär

Tashi

Branca

et al. 2021

Journal of Neurosurgery

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“… 12,13,37,38 Alternatively, the identification of frailty should provide an individualized context for risk stratification of surgery, that informs the discussion between healthcare providers and patient in the decision to accept surgical treatment and discuss the risk of several outcomes such as increased length of stay, delirium and non‐home discharge. This can maximize the benefit and minimize the harm of the surgical intervention while optimizing the use of resources and minimizing cost 39 …”

Section: Discussionmentioning

confidence: 99%

Validation of the Hospital Frailty Risk Score in older surgical patients: A population‐based retrospective cohort study

Gunnarsdottir

Helgadóttir

Einarsson

et al. 2021

Acta Anaesthesiol Scand

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Background There is a need for standardized and cost‐effective identification of frailty risk. The objective was to validate the Hospital Frailty Risk Score which utilizes International Classification Diagnoses in a cohort of older surgical patients, assess the score as an independent risk factor for adverse outcomes and compare discrimination properties of the frailty risk score with other risk stratification scores. Methods Data were analysed from all patients ≥65 years undergoing primary surgical procedures from 2006‐2018. Patients were categorized based on the frailty risk score. The primary outcomes were 30‐day mortality and 180‐day risk of readmission. Results Of 16 793 patients evaluated, 7480 (45%), 7605 (45%) and 1708 (10%) had a low, intermediate and high risk of frailty. There was a higher incidence of 30‐day mortality for individuals with intermediate (2.9%) and high (8.3%) compared with low (1.4%) risk of frailty (P < .001 for both comparisons). Similarly, the hazard of readmission within the first 180 days was higher for intermediate (HR 1.25; 95% CI: 1.16‐1.34) and high (HR 1.84; 95% CI: 1.66‐2.03) compared with low (HR 1.00, P < .001 for both comparisons) risk of frailty. The hazard of long‐term mortality was higher for intermediate (HR 1.70; 95% CI: 1.61‐1.80) and high (HR 4.16; 95% CI: 3.84‐4.49) compared with low (HR 1.00, P < .001 for both comparisons) risk of frailty. Finally, long length of primary hospitalization occurred for 9.3%, 15.0% and 27.3% of individuals with low, intermediate and high frailty risk (P < .001 for all comparisons). A model including age and ASA classification had the best discrimination for 30‐day mortality (AUC 0.862; 95% CI: 0.847‐0.877). Conclusion Our findings suggest that the Hospital Frailty Risk Score might be used to screen older surgical patients for risk of frailty. While only slightly improving prediction of 30‐day mortality using the ASA classification, the Hospital Frailty Risk Score can be used to independently classify older patients for the risk of important outcomes using pre‐existing readily available electronic data.

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“…To be acceptable to clinicians and the patients they serve, frailty must meaningfully inform decisions about care. As the population ages, health care systems face growing numbers of patients with frailty who may derive less benefit or even more harm from aggressive interventions and invasive procedures while adding cost across the system [127,128]. In present circumstances, where specialist geriatrician resources are limited, the entire health care workforce needs to be empowered with valid methods of screening for frailty and delivering bespoke models of care [129].…”

Section: Discussionmentioning

confidence: 99%

Frailty inclusive care in acute and community-based settings: a systematic review protocol

et al. 2021

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Background Frailty is a known risk factor for an array of adverse outcomes including more frequent and prolonged health services use and high health care costs. Aging of the population has implications for care provision across the care continuum, particularly for people living with frailty. Despite known risks associated with frailty, there has been limited research on care pathways that address the needs of persons living with frailty. Our study aims to review and examine, in a rigorous way, the quality of evidence for multi-component interventions and care pathways focused on frailty. Methods A comprehensive electronic search strategy will be used to identify studies that evaluate multi-component interventions or care pathways for persons living with frailty. The search strategy will include terms for frailty, multi-component interventions, effectiveness, and cost effectiveness applied to the following databases: MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews. An adapted search for Google Scholar and gray literature databases will also be used. References of included studies will be hand-searched for additional citations of frailty-inclusive care. Known experts and corresponding authors of identified articles will be contacted by email to identify further eligible studies. Risk of bias will be assessed using the Effective Public Health Practice Project Quality Assessment tool. Data will be extracted from eligible studies and it is anticipated that narrative analysis will be used. If studies with sufficient homogeneity are found, then pooled effects will be reported using meta-analysis. Discussion This review will appraise the evidence currently available on multi-component frailty interventions. Results will inform on clinical pathway development for people living with frailty across the care continuum and will guide future research to address gaps in the literature and areas in need of further development. Systematic review registration PROSPERO CRD42020166733

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Frailty Cost: Economic Impact of Frailty in the Elective Surgical Patient

Cited by 52 publications

References 45 publications

How safe are elective craniotomies in elderly patients in neurosurgery today? A prospective cohort study of 1452 consecutive cases

How safe are elective craniotomies in elderly patients in neurosurgery today? A prospective cohort study of 1452 consecutive cases

Validation of the Hospital Frailty Risk Score in older surgical patients: A population‐based retrospective cohort study

Frailty inclusive care in acute and community-based settings: a systematic review protocol

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