Older adults with serious illness before undergoing elective surgery use nearly twice as many healthcare resources as their healthier counterparts, according to a new study published in the Journal of the American College of Surgeons.
The study found these patients are more likely to have unmet palliative care needs, such as pain and depression, before surgery. Addressing these needs prior to surgery may improve outcomes and reduce costs, the findings suggest.
Researchers from Boston-based Brigham and Women’s Hospital, the National Cancer Center Singapore and Singapore General Hospital examined the pre-surgical palliative care needs of patients aged 66 and older to determine how these needs influenced post-surgical healthcare use. They found that nearly four out of five adults with serious illness had at least one of four key palliative care needs.
Patients with serious illnesses had hospital stays twice as long and were twice as likely to return to the hospital or visit the emergency department within a year. Annual healthcare costs averaged $38,187 for these patients compared with $20,129 for those without serious illness.
Researchers identified four palliative care needs to target before surgery: pain, depression, functional dependence and the need for a care partner.
“Among the four characteristics that we looked at, depression had the highest significance when it comes to having an association with healthcare utilization and costs,” Jolene Si Min Wong, MD, lead study author, said in a news release. Dr. Wong works in the center for surgery and public health at Brigham and Women’s Hospital.
“If you were to choose any target to treat, it should be depression,” she said.
The analysis drew on data from 2,499 patients aged 66 and older who underwent major elective surgery between 2007 and 2019, using the Health and Retirement Survey linked to Medicare claims.
“An important next step would be to see how we can successfully incorporate palliative care practices in the care of seriously ill patients going for routine elective surgery,” Dr. Wong said.
