G. J. Eamer1, L. M. Warkentin1, T. Churchill1, F. Clement2, R. G. Khadaroo1 1University Of Alberta,Department Of Surgery,Edmonton, AB – ALBERTA, Canada 2University Of Calgary,O’Brien Institute For Public Health,Calgary, AB, Canada
Introduction:
Aging populations and improved medical technology have led to increased surgical interventions in the elderly. North Americans aged 65 or older make up 15% of the population in 2015; this is projected to rise to 22% by 2050. Post-operative complications are associated with longer hospital stays, increased cost and lost independence. There is no data examining patients’ accrued personal expenses and lost working days following emergency surgery discharge. This study will estimate the financial and social costs incurred by elderly post-operative patients following acute abdominal surgery.
Methods:
A prospective cohort of 73 patients 65 or older was enrolled in a study of post-surgical interventions to improve outcomes. The patients underwent acute abdominal surgery at either of the two level 1 trauma centers in Alberta, Canada, and completed a 6-month follow-up. Exclusion criteria were elective or palliative surgery, trauma, previous admission, or dependence for 3 or more activities of daily living. A detailed chart review gathered clinical and biochemical data. A validated health resource utilization inventory (HRU) was performed at a 6-month follow-up, which included questions on employment and medical products use. Participants were compared between sites to ensure demographic homogeneity using Fischer’s exact tests or ANOVA. The cost of healthcare products used or purchased in the 6 months following discharge was estimated using government and commercial sources and our HRU. Multivariate linear regression assessed the association of age, preadmission care requirements, post-operative complications and readmission with post-discharge costs.
Results:
Mean age was 79.3 (SD 7.9). More than 98% were Caucasian (n=72); 68% were married; 67% were 3 or less on the Clinical Frailty Scale; and 77% were living independently without care. 62% were classified ASA 3 or 4 (n=45). Following discharge 35% required assistance with cleaning, 30% with shopping, 24% with laundry and meal preparation, 14% with finances and 8% lost employment hours. The mean health care expenditure was 797 Canadian dollars (SD $932, inter-quartiles $157, $1,142, max $4,547) in the 6 months following surgery. Post-discharge cost was associated with needing preadmission care (β 0.313, CI 350-2330, p = 0.009,) as was age (β 0.061, CI 3.7-9.6, p < 0.001). Increased discharge costs were also associated with postoperative complication ($617, β 0.356, CI $283-951, p < 0.001), as was being readmitted ($524, β 0.253, CI $44-1004, p = 0.03).
Conclusion:
Our data demonstrates the significant financial and social costs to patients upon discharge, with an estimated mean cost of $797 in the 6 months post-discharge. Complications pre- and post-discharge also increase out-of-pocket costs to the patient. Reducing complications will not only reduce costs during admission, but also reduce patients’ costs following discharge.