Goldfarb Michael, Bendayan Melissa, Rudski Lawrence G, Morin Jean-Francois, Langlois Yves, Ma Felix, Lachapelle Kevin, Cecere Renzo, DeVarennes Benoit, Tchervenkov Christo I, Brophy James M, Afilalo Jonathan
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.
Can J Cardiol. 2017 Aug;33(8):1020-1026. doi: 10.1016/j.cjca.2017.03.019. Epub 2017 Mar 30.
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.
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.
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).
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.
衰弱是心脏手术后死亡、发病和住院时间延长的危险因素，而这些都是住院费用的主要驱动因素。衰弱患者所产生的额外住院费用尚未得到阐明。
作为麦吉尔衰弱登记研究的一部分，2013年至2015年期间，在2个学术中心对年龄≥60岁的患者在冠状动脉搭桥术或心脏瓣膜手术前进行衰弱评估。从首次手术日期到出院日期计算总费用。采用多变量线性回归来确定在调整传统手术风险因素后术前衰弱状态与总费用之间的关联。
纳入分析的235例患者中，中位年龄为73.0岁（四分位间距[IQR]，70.0 - 78.0岁），68例（29%）为女性。91例衰弱患者的中位费用为32,742美元（IQR，23,221 - 49,627美元），而144例非衰弱患者为23,370美元（IQR，19,977 - 29,705美元）。确定了7例费用超过100,000美元的极端费用病例，这些病例中的所有患者均表现出基线衰弱。在多变量模型中，总费用与衰弱（调整后的额外费用，21,245美元；95%置信区间[CI]，12,418 - 30,073美元；P < 0.001）和瓣膜手术（调整后的额外费用，20,600美元；95%CI，9,661 - 31,539美元；P < 0.001）独立相关。
衰弱与心脏手术后住院费用的显著增加相关，在调整年龄、性别、手术类型和手术风险评分后这种影响依然存在。需要进一步努力优化这一脆弱人群的护理和资源利用。
