Division of Geriatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Ann Surg. 2023 Oct 1;278(4):e726-e732. doi: 10.1097/SLA.0000000000005902. Epub 2023 May 19.
The objective of this study was to evaluate the effect of geriatric surgical pathway (GSP) implementation on inpatient cost of care.
Achieving high-value care for older patients is the goal of the American College of Surgeons Geriatric Verification Program (ACS-GSV). We have previously shown that implementation of our geriatric surgery pathway, which aligns with the ACS-GSV standards, resulted in a reduction in loss of independence and complications.
Patients ≥65 years who underwent an inpatient elective surgical procedure included in the American College of Surgeons National Quality Improvement Program (ACS NSQIP) registry from July 2016 through December 2017 were compared with those patients from February 2018 to December 2019 who were cared for on our GSP. An amalgamation of Clinformatics DataMart, the electronic health record, and the ACS NSQIP registry produced the analytical dataset. We compared mean total and direct costs of care for the entire cohort as well as through propensity matching of frail surgical patients to account for differences in clinical characteristics.
The total mean cost of health care services during hospitalization was significantly lower in the cohort on our GSP ($23,361±$1110) as compared with the precohort ($25,452±$1723), P <0.001. On propensity-matched analysis, cost savings was more evident in our frail geriatric surgery patients.
This study shows that high-value care can be achieved with the implementation of a GSP that aligns with the ACS-GSV program.
本研究旨在评估老年外科路径（GSP）实施对住院护理费用的影响。
实现老年患者的高价值医疗服务是美国外科医师学院老年验证计划（ACS-GSV）的目标。我们之前已经表明，实施与 ACS-GSV 标准一致的老年手术途径，可减少独立性丧失和并发症。
纳入美国外科医师学院国家质量改进计划（ACS NSQIP）登记处 2016 年 7 月至 2017 年 12 月期间接受住院择期手术的年龄≥65 岁患者，并与 2018 年 2 月至 2019 年 12 月期间在我们 GSP 接受治疗的患者进行比较。Clinformatics DataMart、电子健康记录和 ACS NSQIP 登记处的合并产生了分析数据集。我们比较了整个队列以及通过虚弱手术患者的倾向匹配来比较护理总成本和直接成本，以说明临床特征的差异。
与前一队列（$25,452±$1723）相比，GSP 组患者住院期间的医疗服务总成本明显较低（$23,361±$1110），P<0.001。在倾向匹配分析中，我们的脆弱老年手术患者的成本节约更为明显。
这项研究表明，通过实施与 ACS-GSV 计划一致的 GSP 可以实现高价值的医疗服务。
