Department of Surgery, Maine Medical Center, Portland, ME.
Tufts University School of Medicine, Boston, MA.
J Am Coll Surg. 2019 Jun;228(6):861-870. doi: 10.1016/j.jamcollsurg.2019.01.015. Epub 2019 Feb 10.
Frailty in the surgical patient has been associated with increased morbidity, mortality, and failure to rescue. However, there is little understanding of the economic impact of frailty.
A prospective database of elective surgery patients at an academic medical center was used to create a modified version of the Risk Analysis Index (RAI), a validated frailty index. This included 10,257 patients undergoing elective operations from 2016 to 2017. Patients were classified as not frail (RAI = 0), somewhat frail (RAI = 1 to 10), or significantly frail (RAI > 10). Cost, revenue, and income data were procured from the finance department. Univariate and multivariate analyses were performed.
Frail patients were more likely to be older (65 years vs 50 years; p < 0.001) and inpatient (19% vs 36%; p < 0.001). General surgical, gynecologic, urologic, and cardiothoracic services operated on a higher percentage of significantly frail patients compared with orthopaedic, neurosurgical, and vascular (p < 0.001). On univariate analysis, frail patients were more likely to die (0% vs 0.4%; p < 0.001) and have increased length of stay (0.8 vs 2.1 days; p < 0.001), higher total cost ($6,934 vs $13,319), and lower net hospital income ($5,447 vs $3,129) (p < 0.001). On multivariate analysis, frailty was independently associated with increased direct cost (odds ratio [OR] 2.2; p < 0.001), indirect cost (OR 1.9; p < 0.001), total cost (OR 2.2; p < 0.001), and net income (OR 0.8; p < 0.001). Stratified by service line and inpatient vs outpatient status, frailty continued to be associated with increased direct cost, indirect cost, total cost, and decreased hospital income.
Although a significant number of data exist on the impact of frailty in the surgical patient, the economic impacts have only limited description in the literature. Here we demonstrate that frailty, independent of age, has a detrimental financial impact on cost and hospital income in elective surgery.
手术患者的虚弱与发病率、死亡率增加以及救援失败有关。然而，对于虚弱对经济的影响知之甚少。
使用学术医疗中心的择期手术患者的前瞻性数据库，创建了风险分析指数（RAI）的修改版，这是一种经过验证的虚弱指数。该研究纳入了 2016 年至 2017 年期间接受择期手术的 10257 名患者。患者分为不虚弱（RAI=0）、轻度虚弱（RAI=1 至 10）或明显虚弱（RAI>10）。成本、收入和收益数据由财务部门提供。进行了单变量和多变量分析。
虚弱患者更可能年龄较大（65 岁 vs 50 岁；p<0.001）且为住院患者（19% vs 36%；p<0.001）。普通外科、妇科、泌尿科和心胸外科为明显虚弱患者实施手术的比例高于骨科、神经外科和血管外科（p<0.001）。单变量分析显示，虚弱患者死亡的可能性更高（0% vs 0.4%；p<0.001），住院时间更长（0.8 天 vs 2.1 天；p<0.001），总费用更高（6934 美元 vs 13319 美元），净医院收入更低（5447 美元 vs 3129 美元）（p<0.001）。多变量分析显示，虚弱与直接成本增加（比值比 [OR] 2.2；p<0.001）、间接成本增加（OR 1.9；p<0.001）、总费用增加（OR 2.2；p<0.001）和净收入减少（OR 0.8；p<0.001）独立相关。按服务线和住院与门诊患者分层，虚弱与直接成本、间接成本、总费用增加和医院收入减少仍存在相关性。
尽管关于手术患者虚弱的影响有大量数据，但文献中仅对其经济影响进行了有限的描述。在这里，我们证明虚弱独立于年龄对择期手术的成本和医院收入有不利的财务影响。
