Association of Frailty with Healthcare Utilization for Patients over One Year Following Surgical Evaluation

Abstract

Objective: Characterize the distribution of healthcare utilization associated with pre-operative frailty in the year following evaluation by a surgeon.

Summary background data: Frailty is associated with increased morbidity, mortality, and costs for surgical patients. However, the total financial burden for frail patients beyond the index surgery and inpatient stay remains unknown.

Methods: Prospective cohort assembled from February 2016 to December 2020 within a multi-hospital integrated healthcare delivery and finance system (IDFS), from patients evaluated with the Risk Analysis Index (RAI) of frailty. Inclusion criteria: age greater than 18, valid RAI, membership in the IDFS Health Plan. Data were stratified by frailty and surgical status.

Results: The mean (SD) age was 54.7 (16.1) and 58.2% female of the cohort (n=86,572). For all patients with reimbursement for surgery (n=53,856), frail and very frail patients incurred respective increases of 8% ( P =0.027) and 29% ( P <0.001) on utilization relative to the normal group. Robust patients saw a 52% ( P <0.001) decrease. This pattern was more pronounced in the cohort without surgery (n=32,716). The increase over normal utilization for frail and very frail patients increased to 23% ( P =0.004) and 68% ( P <0.001), respectively. Utilization among robust patients decreased 62% ( P <0.001). Increases among the frail were primarily due to increased inpatient medical and post-acute care services (all P <0.001).

Conclusions: Patient frailty is associated with increased total healthcare utilization, primarily via increased inpatient medical and post-acute care following surgery. Quantifying these frailty-related financial burdens may inform clinical decision making as well as the design of value-based reimbursement strategies.

Figure 1.

Inclusion criteria of cohort. Each box stratified into one of four RAI* groups**: robust, normal, frail, and very frail. *RAI: Risk Analysis Index **Groups: Robust = RAI ≤ 29; Normal = RAI 30–36; Frail = RAI 37–44; Very Frail = RAI≥45 †: CHC: Community HealthChoices is Pennsylvania’s mandatory Medicaid managed care program for individuals dually eligible for both Medicaid and Medicare