F. S. Jehan1, M. Hamidi1, N. Kulvatunyou1, A. Tang1, A. Jain1, L. Gries1, T. O’Keeffe1, E. Zakaria1, B. Joseph1 1University Of Arizona,Tucson, AZ, USA
Introduction:
Frailty has been identified as a predictor of adverse post-operative clinical outcomes; however, the financial impact of frailty still remains relatively undetermined in trauma patients. The aim of our study is to evaluate the relationship between frailty and hospital costs among trauma patients treated in a level I trauma center.
Methods:
We performed a two-year (2013-2014) analysis of our prospectively maintained frailty database. We included all trauma patients ≥ 65 years old who underwent laparotomy at our Level 1 trauma center. Patient’s frailty status was calculated utilizing the validated Trauma Specific Frailty Index (TSFI) within 24 hours of admission. Patients were stratified into: non-frail and frail. Multivariate regression analysis was performed to assess the relationship between frailty and total hospital costs and control for confounders.
Results:
325 patients were enrolled, of which 36% (n=117) were frail, and 64% (n=208) were non-frail. Frail status was associated with an average increase of $10,894 in the total hospital cost (median covariate-adjusted cost, frail versus non-frail: $37,174 vs $26,280 p=0.01). Patients who were frail demonstrated a higher total hospital cost within the subgroup of patients who developed a postoperative complication (frail versus non-frail: $45,145 vs $32,210) and among those patients who did not develop a postoperative complication (frail versus non-frail: $29,134 vs $21,673, both p=0.01). Similarly, total hospital costs were higher among patients who were frail regardless of the length of stay for index admission (observed: expected, length of stay > 1: frail versus non-frail: $39,874 vs $28,985; observed: expected, length of stay < 1: frail versus non-frail: $32,512 vs $22,441, both p=0.01).
Conclusion:
Frailty as measured by the TSFI independently predicts hospital costs in trauma patients. TSFI represents a novel tool for estimating patient outcomes and operative costs and can be used to inform quality improvement and cost containment strategies. Once frail patients are identified, appropriate resource allocation can reduce complications and hospital length of stay and can ultimately reduce hospital costs.