Abstract 17008: Increased Cost of Cardiac Surgery in Frail Compared to Non-frail Older Adults
Introduction: While frailty is now well established as a risk factor for mortality and morbidity after cardiac surgery, its role as a determinant of hospital costs has yet to be elucidated.
Methods: Older adults ≥60 years undergoing cardiac surgery at two centers in Montreal, Canada were enrolled in a prospective cohort study aimed at determining the effect of frailty on outcomes. Direct and indirect costing data were subsequently extracted from the Med-GPS electronic hospital accounting system at both centers. Physician fees were estimated from the governmental payment schedule used throughout the province. Total costs were summed from the date of index surgery to the date of hospital discharge. Linear regression was used to determine the association between preoperative frailty status and totals costs, after adjusting for confounders. Frailty was defined as a Fried score ≥3/5 or a Short Physical Performance Battery score ≤5/12.
Results: Among 235 patients included in the analysis, the mean age was 74.0 years and 68 (29%) were female. The median total cost of the index hospitalization was $31,834 for frail patients (N=99) vs. $23,370 for non-frail patients (N=136). In the multivariable model, frailty was the strongest independent predictor of total cost (adjusted beta +$18,054, 95% CI $8,425 to $27,683, P<0.0001) followed by need for combined coronary and valvular surgery. Adding postoperative complications and length of stay to the model did not materially alter the effect of frailty on total cost. Of the extreme cost cases (total cost >$100,000), 7 out of 7 had been identified as frail; excluding these extreme cases did not alter the overall results in sensitivity analysis.
Conclusions: Frailty is associated with a marked increase in hospital costs after cardiac surgery; an effect that persists after adjusting for age, comorbidities, surgery type, and complications.
Author Disclosures: M. Goldfarb: Other Research Support; Significant; Strauss Clinical Fellowship in Medicine. M. Bendayan: None. L. Rudski: None. J. Morin: None. Y. Langlois: None. F. Ma: None. J. Brophy: None. J. Afilalo: None.
- © 2016 by American Heart Association, Inc.