Clinical ResearchCost of Cardiac Surgery in Frail Compared With Nonfrail Older Adults
Section snippets
Study design
We conducted a post hoc analysis of the McGill Frailty Registry, which prospectively enrolled older adults undergoing cardiac surgery at 2 tertiary care academic centres in Montreal, Canada. Patients aged ≥ 60 years were evaluated before elective and urgent CABG or heart valve surgery. Costing data were available from April 1, 2013-March 31, 2014 for the Jewish General Hospital (JGH) and from April 1, 2014-March 31, 2015 for the Royal Victoria Hospital (RVH) based on the date of implementation
Results
A total of 235 patients were included in the analysis. The median age was 73.0 years (IQR, 70.0-78.0 years), and 68 (29%) patients were women. We were able to extract costing data for all patients who underwent cardiac surgery during the calendar years studied. Baseline demographics, clinical characteristics, geriatric domains, and operative data are shown stratified by total cost < $20,000 (corresponding to the 20th percentile), $20,000-$39,000, and ≥ $40,000 (corresponding to the 80th
Discussion
To our knowledge, this is the first study to investigate the incremental cost associated with preoperative frailty in older adults undergoing cardiac surgery. We found that frail patients incurred, on average, an additional $21,245 in total hospitalization costs. This sizeable cost difference was related to a marked increase in major postoperative complications and hospital length of stay. Frailty remained a powerful predictor of hospitalization costs even after adjusting for potential
Conclusions
Frail older adults undergoing cardiac surgery incur substantially higher hospitalization costs than do their nonfrail counterparts. Our study has added to the emerging body of evidence linking frailty with increased costs in noncardiac surgery and inpatient medical care. Given the expansion of the frail older adult population and their growing need for cardiovascular care, these findings have considerable implications for our constrained health care system. Further research is needed to better
Acknowledgements
The authors would like to acknowledge Amanda Trnkus and Marie-Claude Ouimet for their role in managing the McGill Frailty Registry.
Funding Sources
J.A. is supported by a Clinical Research Scholar Award from the Fond de Recherche du Québec en Santé (FRQS) and the Canadian Institutes for Health Research (CIHR). M.G. is supported by the McGill University Strauss Clinical Fellowship.
Disclosures
The authors have no conflicts of interest to disclose.
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2022, Heart and LungCitation Excerpt :Collectively, these imply that preoperative frailty is associated with postoperative maladaptation and the increased need for care. A previous study showed that the cost of cardiac surgery is higher in frail patients than in non-frail patients, with the nursing cost being the most increased.28 This means that frailty significantly increases the level of postoperative care.
Lower extremity performance predicts length of hospital stay in older candidates to elective cardiac surgery
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See editorial by Yanagawa et al., pages 959–960 of this issue.
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