Cost of Cardiac Surgery in Frail Compared With Nonfrail Older Adults

Goldfarb, Michael; Bendayan, Melissa; Rudski, Lawrence; Morin, Jean‐François; Langlois, Yves; Ma, Felix; Lachapelle, Kevin; Cecere, Renzo; DeVarennes, Benoît; Tchervenkov, Christo I.; Brophy, James M.; Afilalo, Jonathan

doi:10.1016/j.cjca.2017.03.019

Cited by 70 publications

(49 citation statements)

References 35 publications

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“…A recent report highlighted an approximately 30% increase in hospitalization cost associated with cardiac surgery in frail patients. 26 The fact that cardiac surgery in frail patients is more costly in and of itself is not surprising, given that the older adult is more prone to longer intensive care unit stays, greater rates of complications, greater blood product use, higher likelihood of transfer to rehabilitation and other nonhome facilities, and hospital readmission and homecare services, all of which drive excess costs.…”

Section: An Economic Argumentmentioning

confidence: 99%

Frailty as a risk predictor in cardiac surgery: Beyond the eyeball test

Yanagawa

Graham

Afilalo

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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Section: An Economic Argumentmentioning

confidence: 99%

Frailty as a risk predictor in cardiac surgery: Beyond the eyeball test

Yanagawa

Graham

Afilalo

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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“…Other studies have found that factors such as patient frailty index and comorbidities are superior indicators for increased healthcare costs [7]. More specifically in the case of cardiac procedures, which accounted for 4 of the 8 identified procedures costlier among older adult patients, frailty has been found to be associated with a marked increase in postoperative hospitalization costs after adjusting for age, sex, surgery type, and surgical risk score [8]. On the other hand, it has also been reported that among octogenarians and septuagenarians undergoing cardiac surgery, total direct cost was higher in the older group of patients [9].…”

Section: Discussionmentioning

confidence: 95%

Cost Comparison of Elective Invasive Procedures between Elderly and Non-Elderly Patients at an Academic Medical Center

Reisman

Farrell

Leitman

2019

Journal of Scientific Innovation in Medicine

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The objective of this study was to determine whether a correlation exists between patient age and hospital expenditures for common complex elective surgical procedures. Hospital charges at an urban academic medical center were categorized by diagnosis related group (DRG) and separated into two cohorts based on patient age (≥65 years old and <65 years old). The costliest elective procedures were identified and the average total hospital cost per procedure was calculated for each group. A Student t-test was performed to compare the average cost per procedure in each cohort and a linear regression model was performed to assess whether a linear correlation existed between patient age and cost per case. Among the costliest elective procedures identified, major elective cardiovascular, spine, and intestinal procedures were costlier in patients ≥65 years. Major transplantation, vascular procedures, and joint replacement surgery were not costlier. Further, none of the identified procedures demonstrated a linear correlation between patient age and cost per case. This finding, combined with other outcome measures, may allow us to reexamine the age limits for these complex procedures.

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“…Studies have either investigated costs incurred among communitydwelling adults whose prevalence of frailty ranges from 6% to 13%, 2,3,[12][13][14] or reported peri-surgical costs in a sicker population with a prevalence of frailty of 38.7%. 15 All have shown higher costs among frail individuals regardless of the length of follow-up time or the prevalence of frailty. 2,5,[12][13][14][15] Compared with these studies, our study highlights the magnitude of Medicare expenditures for the ESRD benefit program (which were at least 3 to 4 times higher among ESRD patients compared with community-dwelling frail elders), the high prevalence of frailty among patients on dialysis, and the association of frailty with higher cost even in this already-high-cost population.…”

Section: Discussionmentioning

confidence: 98%

“…15 All have shown higher costs among frail individuals regardless of the length of follow-up time or the prevalence of frailty. 2,5,[12][13][14][15] Compared with these studies, our study highlights the magnitude of Medicare expenditures for the ESRD benefit program (which were at least 3 to 4 times higher among ESRD patients compared with community-dwelling frail elders), the high prevalence of frailty among patients on dialysis, and the association of frailty with higher cost even in this already-high-cost population. The difference in the mean cost of care for frail compared with nonfrail dialysis patients was considerably larger than the difference between frail and nonfrail community-dwelling elders in most studies.…”

Section: Discussionmentioning

confidence: 98%

The Marginal Cost of Frailty Among Medicare Patients on Hemodialysis

Streja

Grimes

et al. 2020

Kidney International Reports

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Introduction: Dialysis patients incur disproportionately high costs compared with other Medicare beneficiaries. Care for frail individuals may be even more costly. We examined the extent to which frailty contributes to higher costs among dialysis patients. Methods: We used ACTIVE/ADIPOSE (A Cohort to Investigate the Value of Exercise/Analyses Designed to Investigate the Paradox of Obesity and Survival in ESRD) enrollees (adult hemodialysis patients evaluated from June 2009 to August 2011) in a retrospective cohort analysis. Individuals using Medicare as the primary payer were included. Fried's frailty phenotype was evaluated at baseline, 12, and 24 months. Costs were derived from linkage with the US Renal Data System (USRDS) and Medicare claims data. We used generalized estimating equations (GEEs) incorporating time-updated frailty and costs to evaluate adjusted point estimates and the marginal cost associated with being frail. We also investigated if frail patients who died during the study incurred higher costs than those who survived. Results: Among 771 enrollees in ACTIVE/ADIPOSE, 425 met inclusion criteria. Mean age was 56 AE 13 years, body mass index (BMI) 29.2 AE 7.1 kg/m 2 , 42.4% were women, and 29.0% were frail at baseline. Over a mean follow-up of 2.3 years, frail individuals incurred 22% (95% confidence interval [CI] 9.6%-35.8%) higher costs compared with nonfrail individuals ($87,600 per patient per year [pppy], 95% CI 76,800-100,000, vs. $71,800 pppy, 95% CI 64,800-79,600), the difference was driven primarily by higher inpatient expenditures. The difference between frail and nonfrail patients' inpatient expenditures was even more pronounced among those who died during the study compared with those who survived. Conclusions: Frail dialysis patients incur a significantly higher cost relative to their nonfrail counterparts, primarily driven by higher inpatient costs. Frail patients near end of life incur even higher costs.

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Cost of Cardiac Surgery in Frail Compared With Nonfrail Older Adults

Cited by 70 publications

References 35 publications

Frailty as a risk predictor in cardiac surgery: Beyond the eyeball test

Frailty as a risk predictor in cardiac surgery: Beyond the eyeball test

Cost Comparison of Elective Invasive Procedures between Elderly and Non-Elderly Patients at an Academic Medical Center

The Marginal Cost of Frailty Among Medicare Patients on Hemodialysis

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