Impact of Physiological Stress and Reserve on the Cost of Care: Operative Stress Score and Frailty

Physiological stress and reserve negatively impact surgical patients.

Patients undergoing elective surgery were included. Operative stress was defined by operative stress score (OSS) and frailty by Risk Analysis Index.

A total of 6,182 patients were included. With an OSS score of 5, patients were older (67 vs 65.4 years), more likely men (70.2 vs 53.9), had longer length of stay (9.7 vs 3.3 days), and higher mortality (30 days: 3.9 vs 0.7; 90 days: 6.27 vs 1.37; and 120 days: 8.24 vs1.8). Frail patients were older (76 vs 65.4 years), more likely men (68.9 vs 53.9), had higher mortality (30 days: 1.6 vs 0.7; 90 days: 4.4 vs 1.73; and 120 days: 4.7 vs 1.8,), and longer length of stay (4.8 vs 3.3 days). Cost increased with OSS. Net income differed between OSS categories; the highest was OSS of 4 ($9,350 vs mean $5,213, p < 0.001). Total charges and cost increased with increasing frailty (p < 0.0001). There is a decrease in net income with frailty. Overall, for frail patients, there was a net negative income ($-3,658 vs $5,231, p < 0.0001). Trends were similar with each OSS category (1/2, 3, 4, and 5). Net income was negative for almost all OSS categories in frail (1/2: $-3,658; 3: $-4,440; 4: $971; and 5: $-9,932). Net income was positive for commercially insured but negative for most with Medicare.

Increasing OSS was associated with increased cost and profit, and frailty was associated with increased cost and decreased profit. Most with Medicare are cared for at a loss.