Ray Yun Gou1, Tammy T Hshieh1,2,3, Edward R Marcantonio3,4, Zara Cooper3,5, Richard N Jones6,7, Thomas G Travison1,3, Tamara G Fong1,3,8, Ayesha Abdeen3,9, Jeffrey Lange3,10, Brandon Earp3,11, Eva M Schmitt1, Douglas L Leslie11,12, Sharon K Inouye1,3,13. 1. Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts. 2. Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 3. Harvard Medical School, Boston, Massachusetts. 4. Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 5. Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts. 6. Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island. 7. Department of Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island. 8. Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 9. Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 10. Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts. 11. Department of Orthopedic Surgery, Brigham and Women's Faulkner Hospital, Boston, Massachusetts. 12. Center for Applied Studies in Health Economics, Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, Pennsylvania. 13. Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Abstract
Importance: Delirium is a common, serious, and potentially preventable problem for older adults, associated with adverse outcomes. Coupled with its preventable nature, these adverse sequelae make delirium a significant public health concern; understanding its economic costs is important for policy makers and health care leaders to prioritize care. Objective: To evaluate current 1-year health care costs attributable to postoperative delirium in older patients undergoing elective surgery. Design, Setting, and Participants: This prospective cohort study included 497 patients from the Successful Aging after Elective Surgery (SAGES) study, an ongoing cohort study of older adults undergoing major elective surgery. Patients were enrolled from June 18, 2010, to August 8, 2013. Eligible patients were 70 years or older, English-speaking, able to communicate verbally, and scheduled to undergo major surgery at 1 of 2 Harvard-affiliated hospitals with an anticipated length of stay of at least 3 days. Eligible surgical procedures included total hip or knee replacement; lumbar, cervical, or sacral laminectomy; lower extremity arterial bypass surgery; open abdominal aortic aneurysm repair; and open or laparoscopic colectomy. Data were analyzed from October 15, 2019, to September 15, 2020. Exposures: Major elective surgery and hospitalization. Main Outcomes and Measures: Cumulative and period-specific costs (index hospitalization, 30-day, 90-day, and 1-year follow-up) were examined using Medicare claims and extensive clinical data. Total inflation-adjusted health care costs were determined using data from Medicare administrative claims files for the 2010 to 2014 period. Delirium was rated using the Confusion Assessment Method. We also examined whether increasing delirium severity was associated with higher cumulative and period-specific costs. Delirium severity was measured with the Confusion Assessment Method-Severity long form. Regression models were used to determine costs associated with delirium after adjusting for patient demographic and clinical characteristics. Results: Of the 566 patients who were eligible for the study, a total of 497 patients (mean [SD] age, 76.8 [5.1] years; 281 women [57%]; 461 White participants [93%]) were enrolled after exclusion criteria were applied. During the index hospitalization, 122 patients (25%) developed postoperative delirium, whereas 375 (75%) did not. Patients with delirium had significantly higher unadjusted health care costs than patients without delirium (mean [SD] cost, $146 358 [$140 469] vs $94 609 [$80 648]). After adjusting for relevant confounders, the cumulative health care costs attributable to delirium were $44 291 (95% CI, $34 554-$56 673) per patient per year, with the majority of costs coming from the first 90 days: index hospitalization ($20 327), subsequent rehospitalizations ($27 797), and postacute rehabilitation stays ($2803). Health care costs increased directly and significantly with level of delirium severity (none-mild, $83 534; moderate, $99 756; severe, $140 008), suggesting an exposure-response relationship. The adjusted mean cumulative costs attributable to severe delirium were $56 474 (95% CI, $40 927-$77 440) per patient per year. Extrapolating nationally, the health care costs attributable to postoperative delirium were estimated at $32.9 billion (95% CI, $25.7 billion-$42.2 billion) per year. Conclusions and Relevance: These findings suggest that the economic outcomes of delirium and severe delirium after elective surgery are substantial, rivaling costs associated with cardiovascular disease and diabetes. These results highlight the need for policy imperatives to address delirium as a large-scale public health issue.
Importance: Delirium is a common, serious, and potentially preventable problem for older adults, associated with adverse outcomes. Coupled with its preventable nature, these adverse sequelae make delirium a significant public health concern; understanding its economic costs is important for policy makers and health care leaders to prioritize care. Objective: To evaluate current 1-year health care costs attributable to postoperative delirium in older patients undergoing elective surgery. Design, Setting, and Participants: This prospective cohort study included 497 patients from the Successful Aging after Elective Surgery (SAGES) study, an ongoing cohort study of older adults undergoing major elective surgery. Patients were enrolled from June 18, 2010, to August 8, 2013. Eligible patients were 70 years or older, English-speaking, able to communicate verbally, and scheduled to undergo major surgery at 1 of 2 Harvard-affiliated hospitals with an anticipated length of stay of at least 3 days. Eligible surgical procedures included total hip or knee replacement; lumbar, cervical, or sacral laminectomy; lower extremity arterial bypass surgery; open abdominal aortic aneurysm repair; and open or laparoscopic colectomy. Data were analyzed from October 15, 2019, to September 15, 2020. Exposures: Major elective surgery and hospitalization. Main Outcomes and Measures: Cumulative and period-specific costs (index hospitalization, 30-day, 90-day, and 1-year follow-up) were examined using Medicare claims and extensive clinical data. Total inflation-adjusted health care costs were determined using data from Medicare administrative claims files for the 2010 to 2014 period. Delirium was rated using the Confusion Assessment Method. We also examined whether increasing delirium severity was associated with higher cumulative and period-specific costs. Delirium severity was measured with the Confusion Assessment Method-Severity long form. Regression models were used to determine costs associated with delirium after adjusting for patient demographic and clinical characteristics. Results: Of the 566 patients who were eligible for the study, a total of 497 patients (mean [SD] age, 76.8 [5.1] years; 281 women [57%]; 461 White participants [93%]) were enrolled after exclusion criteria were applied. During the index hospitalization, 122 patients (25%) developed postoperative delirium, whereas 375 (75%) did not. Patients with delirium had significantly higher unadjusted health care costs than patients without delirium (mean [SD] cost, $146 358 [$140 469] vs $94 609 [$80 648]). After adjusting for relevant confounders, the cumulative health care costs attributable to delirium were $44 291 (95% CI, $34 554-$56 673) per patient per year, with the majority of costs coming from the first 90 days: index hospitalization ($20 327), subsequent rehospitalizations ($27 797), and postacute rehabilitation stays ($2803). Health care costs increased directly and significantly with level of delirium severity (none-mild, $83 534; moderate, $99 756; severe, $140 008), suggesting an exposure-response relationship. The adjusted mean cumulative costs attributable to severe delirium were $56 474 (95% CI, $40 927-$77 440) per patient per year. Extrapolating nationally, the health care costs attributable to postoperative delirium were estimated at $32.9 billion (95% CI, $25.7 billion-$42.2 billion) per year. Conclusions and Relevance: These findings suggest that the economic outcomes of delirium and severe delirium after elective surgery are substantial, rivaling costs associated with cardiovascular disease and diabetes. These results highlight the need for policy imperatives to address delirium as a large-scale public health issue.
Authors: Yuta Katsumi; Bonnie Wong; Michele Cavallari; Tamara G Fong; David C Alsop; Joseph M Andreano; Nicole Carvalho; Michael Brickhouse; Richard Jones; Towia A Libermann; Edward R Marcantonio; Eva Schmitt; Mouhsin M Shafi; Alvaro Pascual-Leone; Thomas Travison; Lisa Feldman Barrett; Sharon K Inouye; Bradford C Dickerson; Alexandra Touroutoglou Journal: Brain Commun Date: 2022-06-28
Authors: Adam D Shellito; Jill Q Dworsky; Patrick J Kirkland; Ronnie A Rosenthal; Catherine A Sarkisian; Clifford Y Ko; Marcia M Russell Journal: Ann Surg Open Date: 2021-09
Authors: Douglas L Leslie; Donna M Fick; Amber Moore; Sharon K Inouye; Yoojin Jung; Long H Ngo; Marie Boltz; Erica Husser; Priyanka Shrestha; Malaz Boustani; Edward R Marcantonio Journal: J Am Geriatr Soc Date: 2022-04-20 Impact factor: 7.538
Authors: Franchesca Arias; Margarita Alegria; Amy J Kind; Richard N Jones; Thomas G Travison; Edward R Marcantonio; Eva M Schmitt; Tamara G Fong; Sharon K Inouye Journal: J Am Geriatr Soc Date: 2021-10-25 Impact factor: 5.562