• Stephen J Flinn, David S Silver, Jacob Hodges, Andrew L Bilderback, Dan Buchanan, Justin M Ludwig, James Schuster, and Daniel E Hall.
• University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
• Ann. Surg. 2024 Jan 24.

ObjectiveCharacterize the distribution of healthcare utilization associated with pre-operative frailty in the year following evaluation by a surgeon.Summary Background DataFrailty 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.MethodsProspective 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.ResultsThe 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).ConclusionsPatient 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.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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