TY - JOUR
T1 - One-Year Medicare Costs Associated with Delirium in Older Patients Undergoing Major Elective Surgery
AU - Gou, Ray Yun
AU - Hshieh, Tammy T.
AU - Marcantonio, Edward R.
AU - Cooper, Zara
AU - Jones, Richard N.
AU - Travison, Thomas G.
AU - Fong, Tamara G.
AU - Abdeen, Ayesha
AU - Lange, Jeffrey
AU - Earp, Brandon
AU - Schmitt, Eva M.
AU - Leslie, Douglas L.
AU - Inouye, Sharon K.
N1 - Funding Information:
part by grants from the National Institute on Aging grant nos. P01AG031720 (SKI), R24AG054259 (SKI), R01AG044518 (SKI/RNJ). Dr Marcantonio’s time was supported in part by grant nos. K24AG035075 (ERM) and R01AG030618; Dr Fong’s time in part by R21AG057955 (TGF). Dr Inouye holds the Milton and Shirley F. Levy Family Chair at Hebrew SeniorLife/Harvard Medical School.
Funding Information:
reported receiving royalties/honorarium from OnPoint Knee for serving on their scientific advisory board and serving as committee member for the American Association of Hip and Knee Surgeons outside the submitted work. Dr Earp reported receiving stock ownership from Johnson and Johnson and stock ownership from Pfizer outside the submitted work. Dr Leslie reported receiving grants from the National Institutes of Health during the conduct of the study. No other disclosures were reported.
Publisher Copyright:
© 2021 American Medical Association. All rights reserved.
PY - 2021/5
Y1 - 2021/5
N2 - Importance: Delirium is a common, serious, and potentially preventable problem for older adults, associated with adverse outcomes. Coupled with its preventable nature, these adverse sequelae make delirium a significant public health concern; understanding its economic costs is important for policy makers and health care leaders to prioritize care. Objective: To evaluate current 1-year health care costs attributable to postoperative delirium in older patients undergoing elective surgery. Design, Setting, and Participants: This prospective cohort study included 497 patients from the Successful Aging after Elective Surgery (SAGES) study, an ongoing cohort study of older adults undergoing major elective surgery. Patients were enrolled from June 18, 2010, to August 8, 2013. Eligible patients were 70 years or older, English-speaking, able to communicate verbally, and scheduled to undergo major surgery at 1 of 2 Harvard-affiliated hospitals with an anticipated length of stay of at least 3 days. Eligible surgical procedures included total hip or knee replacement; lumbar, cervical, or sacral laminectomy; lower extremity arterial bypass surgery; open abdominal aortic aneurysm repair; and open or laparoscopic colectomy. Data were analyzed from October 15, 2019, to September 15, 2020. Exposures: Major elective surgery and hospitalization. Main Outcomes and Measures: Cumulative and period-specific costs (index hospitalization, 30-day, 90-day, and 1-year follow-up) were examined using Medicare claims and extensive clinical data. Total inflation-adjusted health care costs were determined using data from Medicare administrative claims files for the 2010 to 2014 period. Delirium was rated using the Confusion Assessment Method. We also examined whether increasing delirium severity was associated with higher cumulative and period-specific costs. Delirium severity was measured with the Confusion Assessment Method-Severity long form. Regression models were used to determine costs associated with delirium after adjusting for patient demographic and clinical characteristics. Results: Of the 566 patients who were eligible for the study, a total of 497 patients (mean [SD] age, 76.8 [5.1] years; 281 women [57%]; 461 White participants [93%]) were enrolled after exclusion criteria were applied. During the index hospitalization, 122 patients (25%) developed postoperative delirium, whereas 375 (75%) did not. Patients with delirium had significantly higher unadjusted health care costs than patients without delirium (mean [SD] cost, 146358 [140469] vs 94609 [80648]). After adjusting for relevant confounders, the cumulative health care costs attributable to delirium were 44291 (95% CI, 34554-56673) per patient per year, with the majority of costs coming from the first 90 days: index hospitalization (20 327), subsequent rehospitalizations (27 797), and postacute rehabilitation stays (2803). Health care costs increased directly and significantly with level of delirium severity (none-mild, 83 534; moderate, 99 756; severe, 140 008), suggesting an exposure-response relationship. The adjusted mean cumulative costs attributable to severe delirium were 56474 (95% CI, 40927-77440) per patient per year. Extrapolating nationally, the health care costs attributable to postoperative delirium were estimated at 32.9 billion (95% CI, 25.7 billion-42.2 billion) per year. Conclusions and Relevance: These findings suggest that the economic outcomes of delirium and severe delirium after elective surgery are substantial, rivaling costs associated with cardiovascular disease and diabetes. These results highlight the need for policy imperatives to address delirium as a large-scale public health issue..
AB - Importance: Delirium is a common, serious, and potentially preventable problem for older adults, associated with adverse outcomes. Coupled with its preventable nature, these adverse sequelae make delirium a significant public health concern; understanding its economic costs is important for policy makers and health care leaders to prioritize care. Objective: To evaluate current 1-year health care costs attributable to postoperative delirium in older patients undergoing elective surgery. Design, Setting, and Participants: This prospective cohort study included 497 patients from the Successful Aging after Elective Surgery (SAGES) study, an ongoing cohort study of older adults undergoing major elective surgery. Patients were enrolled from June 18, 2010, to August 8, 2013. Eligible patients were 70 years or older, English-speaking, able to communicate verbally, and scheduled to undergo major surgery at 1 of 2 Harvard-affiliated hospitals with an anticipated length of stay of at least 3 days. Eligible surgical procedures included total hip or knee replacement; lumbar, cervical, or sacral laminectomy; lower extremity arterial bypass surgery; open abdominal aortic aneurysm repair; and open or laparoscopic colectomy. Data were analyzed from October 15, 2019, to September 15, 2020. Exposures: Major elective surgery and hospitalization. Main Outcomes and Measures: Cumulative and period-specific costs (index hospitalization, 30-day, 90-day, and 1-year follow-up) were examined using Medicare claims and extensive clinical data. Total inflation-adjusted health care costs were determined using data from Medicare administrative claims files for the 2010 to 2014 period. Delirium was rated using the Confusion Assessment Method. We also examined whether increasing delirium severity was associated with higher cumulative and period-specific costs. Delirium severity was measured with the Confusion Assessment Method-Severity long form. Regression models were used to determine costs associated with delirium after adjusting for patient demographic and clinical characteristics. Results: Of the 566 patients who were eligible for the study, a total of 497 patients (mean [SD] age, 76.8 [5.1] years; 281 women [57%]; 461 White participants [93%]) were enrolled after exclusion criteria were applied. During the index hospitalization, 122 patients (25%) developed postoperative delirium, whereas 375 (75%) did not. Patients with delirium had significantly higher unadjusted health care costs than patients without delirium (mean [SD] cost, 146358 [140469] vs 94609 [80648]). After adjusting for relevant confounders, the cumulative health care costs attributable to delirium were 44291 (95% CI, 34554-56673) per patient per year, with the majority of costs coming from the first 90 days: index hospitalization (20 327), subsequent rehospitalizations (27 797), and postacute rehabilitation stays (2803). Health care costs increased directly and significantly with level of delirium severity (none-mild, 83 534; moderate, 99 756; severe, 140 008), suggesting an exposure-response relationship. The adjusted mean cumulative costs attributable to severe delirium were 56474 (95% CI, 40927-77440) per patient per year. Extrapolating nationally, the health care costs attributable to postoperative delirium were estimated at 32.9 billion (95% CI, 25.7 billion-42.2 billion) per year. Conclusions and Relevance: These findings suggest that the economic outcomes of delirium and severe delirium after elective surgery are substantial, rivaling costs associated with cardiovascular disease and diabetes. These results highlight the need for policy imperatives to address delirium as a large-scale public health issue..
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U2 - 10.1001/jamasurg.2020.7260
DO - 10.1001/jamasurg.2020.7260
M3 - Article
C2 - 33625501
AN - SCOPUS:85101786312
VL - 156
SP - 430
EP - 442
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
IS - 5
ER -