Frailty and Long-Term Health Care Utilization After Elective General and Vascular Surgery

Area of Science:

• Geriatric Medicine
• Surgical Outcomes
• Health Services Research

Background:

• Surgical quality improvement traditionally focuses on short-term outcomes (e.g., 30-day readmissions).
• The long-term impact of surgery on health care utilization for frail patients remains understudied.
• Frailty may significantly affect post-surgical quality of life and resource utilization.

Purpose of the Study:

• To investigate the independent association between preoperative frailty and long-term health care utilization up to 24 months after elective surgery.
• To quantify the risk of increased healthcare resource use in frail surgical patients.

Main Methods:

• Retrospective observational cohort study of 183,343 patients undergoing elective general and vascular surgery in the Veterans Affairs system (2013-2018).
• Frailty assessed using the Risk Analysis Index (RAI-A) score.
• Health care utilization (inpatient admissions, outpatient visits, ED visits, nursing home/rehabilitation) tracked for 24 months post-discharge.
• Cox proportional hazards models used for adjusted analyses.

Main Results:

• Preoperative frailty was significantly associated with increased long-term health care utilization.
• Frail patients showed higher inpatient admissions (HR 1.75) and very frail patients (HR 2.33) compared to robust patients.
• Frail patients had more ED visits (HR 1.39) and very frail patients (HR 1.70).
• Nursing home or rehabilitation encounters were substantially higher for frail (HR 4.97) and very frail (HR 7.44) patients, persisting for 24 months.

Conclusions:

• Preoperative frailty is a significant predictor of elevated long-term health care utilization following surgery.
• Findings highlight potential implications for patient quality of life and necessitate strategic planning for health care systems and payers.
• Further research into interventions to mitigate long-term resource use in frail surgical populations is warranted.