Michael Goldfarb1, Melissa Bendayan1, Lawrence G Rudski2, Jean-Francois Morin3, Yves Langlois3, Felix Ma3, Kevin Lachapelle4, Renzo Cecere4, Benoit DeVarennes4, Christo I Tchervenkov4, James M Brophy5, Jonathan Afilalo6. 1. Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology, Lady Davis Institute, McGill University, Montreal, Quebec, Canada. 2. Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. 3. Division of Cardiac Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. 4. Division of Cardiac Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada. 5. Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada. 6. Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology, Lady Davis Institute, McGill University, Montreal, Quebec, Canada; Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. Electronic address: jonathan.afilalo@mcgill.ca.
Abstract
BACKGROUND: Frailty is a risk factor for mortality, morbidity, and prolonged length of stay after cardiac surgery, all of which are major drivers of hospitalization costs. The incremental hospitalization costs incurred in frail patients have yet to be elucidated. METHODS: Patients aged ≥ 60 years were evaluated for frailty before coronary artery bypass grafting or heart valve surgery at 2 academic centres between 2013 and 2015 as part of the McGill Frailty Registry. Total costs were summed from the date of the index surgery to the date of hospital discharge. Mutivariable linear regression was used to determine the association between preoperative frailty status and total costs after adjusting for conventional surgical risk factors. RESULTS: Among 235 patients included in the analysis, the median age was 73.0 years (interquartile range [IQR], 70.0-78.0 years) and 68 (29%) were women. The median cost was $32,742 (IQR, $23,221-$49,627) in 91 frail patients compared with $23,370 (IQR, $19,977-$29,705) in 144 nonfrail patients. Seven extreme-cost cases > $100,000 were identified, and all of the patients in these cases exhibited baseline frailty. In the multivariable model, total costs were independently associated with frailty (adjusted additional cost, $21,245; 95% confidence interval [CI], $12,418-$30,073; P < 0.001) and valve surgery (adjusted additional cost, $20,600; 95% CI, $9,661-$31,539; P < 0.001). CONCLUSIONS: Frailty is associated with a marked increase in hospitalization costs after cardiac surgery, an effect that persists after adjusting for age, sex, surgery type, and surgical risk score. Further efforts are needed to optimize care and resource use in this vulnerable population.
BACKGROUND: Frailty is a risk factor for mortality, morbidity, and prolonged length of stay after cardiac surgery, all of which are major drivers of hospitalization costs. The incremental hospitalization costs incurred in frail patients have yet to be elucidated. METHODS:Patients aged ≥ 60 years were evaluated for frailty before coronary artery bypass grafting or heart valve surgery at 2 academic centres between 2013 and 2015 as part of the McGill Frailty Registry. Total costs were summed from the date of the index surgery to the date of hospital discharge. Mutivariable linear regression was used to determine the association between preoperative frailty status and total costs after adjusting for conventional surgical risk factors. RESULTS: Among 235 patients included in the analysis, the median age was 73.0 years (interquartile range [IQR], 70.0-78.0 years) and 68 (29%) were women. The median cost was $32,742 (IQR, $23,221-$49,627) in 91 frail patients compared with $23,370 (IQR, $19,977-$29,705) in 144 nonfrail patients. Seven extreme-cost cases > $100,000 were identified, and all of the patients in these cases exhibited baseline frailty. In the multivariable model, total costs were independently associated with frailty (adjusted additional cost, $21,245; 95% confidence interval [CI], $12,418-$30,073; P < 0.001) and valve surgery (adjusted additional cost, $20,600; 95% CI, $9,661-$31,539; P < 0.001). CONCLUSIONS: Frailty is associated with a marked increase in hospitalization costs after cardiac surgery, an effect that persists after adjusting for age, sex, surgery type, and surgical risk score. Further efforts are needed to optimize care and resource use in this vulnerable population.
Authors: Robert B Hawkins; J Hunter Mehaffey; Eric J Charles; John A Kern; D Scott Lim; Nicholas R Teman; Gorav Ailawadi Journal: Ann Thorac Surg Date: 2018-03-09 Impact factor: 4.330
Authors: Deyu Meng; Hongzhi Guo; Siyu Liang; Zhibo Tian; Ran Wang; Guang Yang; Ziheng Wang Journal: Int J Environ Res Public Health Date: 2022-06-07 Impact factor: 4.614
Authors: Ziyi Wang; Deyu Meng; Shichun He; Hongzhi Guo; Zhibo Tian; Meiqi Wei; Guang Yang; Ziheng Wang Journal: Int J Environ Res Public Health Date: 2022-09-04 Impact factor: 4.614
Authors: Andy Ton; Shane Shahrestani; Nima Saboori; Alexander M Ballatori; Xiao T Chen; Jeffrey C Wang; Zorica Buser Journal: Eur Spine J Date: 2022-05-12 Impact factor: 2.721
Authors: Ryan Howard; Yue S Yin; Lane McCandless; Stewart Wang; Michael Englesbe; David Machado-Aranda Journal: J Am Coll Surg Date: 2018-10-22 Impact factor: 6.113
Authors: Derek King Wai Yau; Man Kin Henry Wong; Wai-Tat Wong; Tony Gin; Malcolm John Underwood; Gavin Mathew Joynt; Anna Lee Journal: BMJ Open Date: 2019-05-14 Impact factor: 2.692
Authors: Zhe Li; Steven Habbous; Jenny Thain; Daniel E Hall; A Dave Nagpal; Rodrigo Bagur; Bob Kiaii; Ava John-Baptiste Journal: Can J Cardiol Date: 2019-10-12 Impact factor: 5.223