Featured Author Podcast: Frailty and Perioperative Costs
Jul 24, 2023
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Dr. Daniel I. McIsaac discusses his study on the economic impact of frailty in perioperative patients. The podcast explores secondary outcomes and study design, analyzing healthcare data and its benefits for research, study dates and surgery types, challenges of studying frailty in healthcare settings, and the impact of frailty on surgery types and costs.
Older patients with frailty incur significantly higher healthcare costs after major elective non-cardiac surgery, driven primarily by acute hospitalization and post-acute care.
The impact of frailty on costs varies depending on the type of surgery, with joint replacements showing a greater relative impact compared to more invasive surgeries, emphasizing the need for tailored care for frail patients.
Deep dives
The Economic Impact of Frailty in Perioperative Patients
Frailty is a well-established risk factor for clinical adverse events in the early post-operative period. However, there is a lack of understanding regarding the economic impact of frailty in perioperative patients. This study aimed to fill this research gap by examining the costs associated with frailty in the perioperative period. The study found that older patients with frailty incurred significantly higher healthcare costs after major elective non-cardiac surgery compared to those without frailty. The costs were primarily driven by acute hospitalization and post-acute care, highlighting the need for increased support and resources for frail individuals undergoing surgery.
Capturing Frailty and Health Care Costs
The study used a well-validated frailty index to capture frailty in a population-based cohort. Data from Ontario's health administrative records were utilized, providing a reliable source for healthcare cost information. This allowed for a comprehensive analysis of costs over different time periods, including costs accrued within the first 30 days, up to 90 days, and over the first year after surgery. By pre-specifying the exposure and outcome measures, the study ensured a robust analysis and adjusted for confounding factors, providing reliable estimates of the costs attributable to frailty.
The Impact of Frailty on Surgical Procedures
The study found that the impact of frailty on costs varied depending on the type of surgery. Interestingly, the relative impact of frailty on costs was greater for joint replacements compared to more invasive surgeries like Whipple procedures and aortic repair. This aligns with previous studies that have shown higher associations between frailty and adverse outcomes after joint replacements. The findings highlight the importance of recognizing frailty and ensuring appropriate vigilance and multidisciplinary care for frail patients, regardless of the type of surgery they undergo.
Implications and Future Research
The study's findings have important implications for healthcare planning and resource allocation. With the increasing prevalence of frailty in the aging population, the higher costs associated with frailty have significant implications for healthcare funding and sustainability. Future research should focus on understanding the economic burden of caring for frail individuals beyond healthcare system costs, including out-of-pocket expenses and the impact on caregivers and family members. Additionally, further exploration of the interaction between frailty, surgical procedures, and outcomes can help guide perioperative care for frail patients and improve their overall outcomes.