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One-Year Medicare Costs Associated With Delirium in Older Patients Undergoing Major Elective Surgery.
Gou, Ray Yun; Hshieh, Tammy T; Marcantonio, Edward R; Cooper, Zara; Jones, Richard N; Travison, Thomas G; Fong, Tamara G; Abdeen, Ayesha; Lange, Jeffrey; Earp, Brandon; Schmitt, Eva M; Leslie, Douglas L; Inouye, Sharon K.
Affiliation
  • Gou RY; Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
  • Hshieh TT; Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
  • Marcantonio ER; Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
  • Cooper Z; Harvard Medical School, Boston, Massachusetts.
  • Jones RN; Harvard Medical School, Boston, Massachusetts.
  • Travison TG; Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
  • Fong TG; Harvard Medical School, Boston, Massachusetts.
  • Abdeen A; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
  • Lange J; Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
  • Earp B; Department of Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
  • Schmitt EM; Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
  • Leslie DL; Harvard Medical School, Boston, Massachusetts.
  • Inouye SK; Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
JAMA Surg ; 156(5): 430-442, 2021 05 01.
Article de En | MEDLINE | ID: mdl-33625501
ABSTRACT
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, $146 358 [$140 469] vs $94 609 [$80 648]). After adjusting for relevant confounders, the cumulative health care costs attributable to delirium were $44 291 (95% CI, $34 554-$56 673) 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 $56 474 (95% CI, $40 927-$77 440) 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.
Sujet(s)

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Sujet principal: Medicare (USA) / Coûts des soins de santé / Interventions chirurgicales non urgentes / Délire avec confusion Type d'étude: Etiology_studies / Health_economic_evaluation / Observational_studies / Prognostic_studies / Risk_factors_studies Limites: Aged / Aged80 / Female / Humans / Male Pays/Région comme sujet: America do norte Langue: En Journal: JAMA Surg Année: 2021 Type de document: Article

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Sujet principal: Medicare (USA) / Coûts des soins de santé / Interventions chirurgicales non urgentes / Délire avec confusion Type d'étude: Etiology_studies / Health_economic_evaluation / Observational_studies / Prognostic_studies / Risk_factors_studies Limites: Aged / Aged80 / Female / Humans / Male Pays/Région comme sujet: America do norte Langue: En Journal: JAMA Surg Année: 2021 Type de document: Article