Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Anesthesiology. 2023 Aug 1;139(2):143-152. doi: 10.1097/ALN.0000000000004601.
Patients with frailty consistently experience higher rates of perioperative morbidity and mortality; however, costs attributable to frailty remain poorly defined. This study sought to identify older patients with and without frailty using a validated, multidimensional frailty index and estimated the attributable costs in the year after major, elective noncardiac surgery.
The authors conducted a retrospective population-based cohort study of all patients 66 yr or older having major, elective noncardiac surgery between April 1, 2012, and March 31, 2018, using linked health data obtained from an independent research institute (ICES) in Ontario, Canada. All data were collected using standard methods from the date of surgery to the end of 1-yr follow-up. The presence or absence of preoperative frailty was determined using a multidimensional frailty index. The primary outcome was total health system costs in the year after surgery using a validated patient-level costing method capturing direct and indirect costs. Secondary outcomes included costs to postoperative days 30 and 90 along with sensitivity analyses and evaluation of effect modifiers.
Of 171,576 patients, 23,219 (13.5%) were identified with preoperative frailty. Unadjusted costs were higher among patients with frailty (ratio of means 1.79, 95% CI 1.76 to 1.83). After adjusting for confounders, an absolute cost increase of $11,828 Canadian dollar (ratio of means 1.53; 95% CI, 1.51 to 1.56) was attributable to frailty. This association was attenuated with additional control for comorbidities (ratio of means 1.24, 95% CI, 1.22 to 1.26). Among contributors to total costs, frailty was most strongly associated with increased postacute care costs.
For patients with preoperative frailty having elective surgery, the authors estimate that attributable costs are increased 1.5-fold in the year after major, elective noncardiac surgery. These data inform resource allocation for patients with frailty.
虚弱的患者在围手术期始终具有更高的发病率和死亡率；然而，虚弱导致的成本仍未得到明确界定。本研究旨在使用经过验证的多维虚弱指数确定患有和不患有虚弱的老年患者，并估计在进行主要择期非心脏手术后的一年中可归因的成本。
作者对 2012 年 4 月 1 日至 2018 年 3 月 31 日期间在加拿大安大略省独立研究机构（ICES）进行的所有 66 岁或以上的择期非心脏手术的主要患者进行了回顾性基于人群的队列研究。所有数据均使用标准方法从手术日期收集至 1 年随访结束。使用多维虚弱指数确定术前虚弱的存在与否。主要结局是使用经过验证的患者水平成本法评估手术 1 年后的总医疗系统成本，该方法可捕获直接和间接成本。次要结局包括术后 30 天和 90 天的成本以及敏感性分析和效应修饰剂的评估。
在 171576 名患者中，有 23219 名（13.5%）患者术前患有虚弱。虚弱患者的未调整成本更高（均值比 1.79，95%置信区间 1.76 至 1.83）。在调整混杂因素后，可归因于虚弱的绝对成本增加了 11828 加元（均值比 1.53；95%置信区间，1.51 至 1.56）。进一步控制合并症后，这种关联减弱（均值比 1.24，95%置信区间，1.22 至 1.26）。在总费用的各项贡献中，虚弱与急性后护理费用增加的关系最密切。
对于术前患有虚弱的择期手术患者，作者估计，在进行主要择期非心脏手术后的一年中，可归因的成本增加了 1.5 倍。这些数据为虚弱患者的资源分配提供了信息。
