Cost of major surgery in the sarcopenic patient

Abstract

Background: Sarcopenia is associated with poor outcomes after major surgery. There are currently no data regarding the financial implications of providing care for these high-risk patients.

Study design: We identified 1,593 patients within the Michigan Surgical Quality Collaborative (MSQC) who underwent elective major general or vascular surgery at a single institution between 2006 and 2011. Patient sarcopenia, determined by lean psoas area (LPA), was derived from preoperative CT scans using validated analytic morphomic methods. Financial data including hospital revenue and direct costs were acquired for each patient through the hospital's finance department. Financial data were adjusted for patient and procedural factors using multiple linear regression methods, and Mann-Whitney U test was used for significance testing.

Results: After controlling for patient and procedural factors, decreasing LPA was independently associated with increasing payer costs ($6,989.17 per 1,000 mm(2) LPA, p < 0.001). The influence of LPA on payer costs increased to $26,988.41 per 1,000 mm(2) decrease in LPA (p < 0.001) in patients who experienced a postoperative complication. Further, the covariate-adjusted hospital margin decreased by $2,620 per 1,000 mm(2) decrease in LPA (p < 0.001) such that average negative margins were observed in the third of patients with the smallest LPA.

Conclusions: Sarcopenia is associated with high payer costs and negative margins after major surgery. Although postoperative complications are universally expensive to payers and providers, sarcopenic patients represent a uniquely costly patient demographic. Given that sarcopenia may be remediable, efforts to attenuate costs associated with major surgery should focus on targeted preoperative interventions to optimize these high risk patients for surgery.

Figure 1

Covariate adjusted payer costs. Sarcopenia is significantly associated with higher payer costs. After adjusting for patient and procedural covariates, patient costs varied nearly 3-fold across the observed range of lean psoas area.

Figure 2

Covariate adjusted payer costs. Patients were grouped in to tertiles of lean psoas area. Payer costs in sarcopenic patients were significantly higher that non-sarcopenic patients in those with zero, one, and multiple complications (*denotes significance, p<0.001 for all). Black bar, no complications; light gray bar, 1 complication; dark gray bar, multiple complications.

Figure 3

Distribution of total hospital costs. The percentage of hospital costs attributed to the sarcopenic tertile of patients is significantly higher than those incurred by average and non-sarcopenic patients.

Figure 4

Covariate adjusted hospital margin. Lean psoas area is associated with overall hospital margin. Sarcopenic patients represented an overall negative margin for the hospital.