Costs Associated With Delirium After Elective Surgery

3 years ago

Costs Associated With Delirium After Elective Surgery

Ray Yun Gou, Tammy T. Hshieh, Edward R. Marcantonio, Zara Cooper, Richard N. Jones, Thomas G. Travison, Tamara G. Fong, Ayesha Abdeen, Jeffrey Lange, Brandon Earp, Eva M. Schmitt, Douglas L. Leslie, Sharon K. Inouye, SAGES Study Group

Question What Medicare costs are attributable to delirium after elective surgery each year? Findings In this cohort study of 497 older adults undergoing major elective surgery, the cumulative costs attributable to delirium were 56 474 per patient over 1 year. Meaning Results suggest that incident delirium and severe delirium after elective surgery are associated with a high cost to the health care system, with substantial public health implications that warrant renewed efforts to bolster prevention, early detection, and management of delirium. Importance Delirium is a common, serious, and potentially preventable problem for older adults, associated with adverse outcomes. Coupled with its preventable nature, these adverse sequelae make delirium a significant public health concern; understanding its economic costs is important for policy makers and health care leaders to prioritize care. Objective To evaluate current 1-year health care costs attributable to postoperative delirium in older patients undergoing elective surgery. Design, Setting, and Participants This prospective cohort study included 497 patients from the Successful Aging after Elective Surgery (SAGES) study, an ongoing cohort study of older adults undergoing major elective surgery. Patients were enrolled from June 18, 2010, to August 8, 2013. Eligible patients were 70 years or older, English-speaking, able to communicate verbally, and scheduled to undergo major surgery at 1 of 2 Harvard-affiliated hospitals with an anticipated length of stay of at least 3 days. Eligible surgical procedures included total hip or knee replacement; lumbar, cervical, or sacral laminectomy; lower extremity arterial bypass surgery; open abdominal aortic aneurysm repair; and open or laparoscopic colectomy. Data were analyzed from October 15, 2019, to September 15, 2020. Exposures Major elective surgery and hospitalization. Main Outcomes and Measures Cumulative and period-specific costs (index hospitalization, 30-day, 90-day, and 1-year follow-up) were examined using Medicare claims and extensive clinical data. Total inflation-adjusted health care costs were determined using data from Medicare administrative claims files for the 2010 to 2014 period. Delirium was rated using the Confusion Assessment Method. We also examined whether increasing delirium severity was associated with higher cumulative and period-specific costs. Delirium severity was measured with the Confusion Assessment Method–Severity long form. Regression models were used to determine costs associated with delirium after adjusting for patient demographic and clinical characteristics. Results Of the 566 patients who were eligible for the study, a total of 497 patients (mean [SD] age, 76.8 [5.1] years; 281 women [57%]; 461 White participants [93%]) were enrolled after exclusion criteria were applied. During the index hospitalization, 122 patients (25%) developed postoperative delirium, whereas 375 (75%) did not. Patients with delirium had significantly higher unadjusted health care costs than patients without delirium (mean [SD] cost, 140 469] vs 80 648]). After adjusting for relevant confounders, the cumulative health care costs attributable to delirium were 34 554-20 327), subsequent rehospitalizations (2803). Health care costs increased directly and significantly with level of delirium severity (none-mild, 99 756; severe, 56 474 (95% CI, 77 440) per patient per year. Extrapolating nationally, the health care costs attributable to postoperative delirium were estimated at 25.7 billion-$42.2 billion) per year. Conclusions and Relevance These findings suggest that the economic outcomes of delirium and severe delirium after elective surgery are substantial, rivaling costs associated with cardiovascular disease and diabetes. These results highlight the need for policy imperatives to address delirium as a large-scale public health issue.

Publisher URL: https://jamanetwork.com/journals/jamasurgery/fullarticle/2776767

DOI: 10.1001/jamasurg.2020.7260