Older adults living with serious illness face significantly more challenges and costs following elective surgeries, according to new research published in the Journal of the American College of Surgeons.
The study reveals that patients 66 and older with pre-existing serious illness had hospital stays twice as long, were twice as likely to return to the hospital or emergency department, and incurred nearly double the annual health care costs compared to similarly aged peers without serious illness.
Led by Dr. Jolene Wong Si Min of the Center for Surgery and Public Health at Brigham and Women’s Hospital in Boston, and affiliated with the National Cancer Center Singapore and Singapore General Hospital, the research aimed to identify opportunities for integrating palliative care into surgical treatment.
“We were looking at the palliative care needs of this group of patients to see whether we could identify points to intervene,” said Dr. Wong. “These needs were high in older adults with serious illness and who were going for major elective surgery.”
Study Details and Population
The researchers examined data from 2,499 patients aged 66 and older who underwent major elective surgeries between 2007 and 2019. Patient data was sourced from the national Health and Retirement Survey and linked Medicare claims, allowing researchers to evaluate both clinical characteristics and outcomes.
Key findings include:
79% of patients showed at least one palliative care indicator prior to surgery, including moderate-to-severe pain, depression, functional dependence, or the need for a care partner.
63% had a qualifying serious illness before surgery.
Seriously ill patients had higher hospital utilization rates post-surgery compared to their healthier counterparts.
Average adjusted one-year health care costs for seriously ill patients reached $38,187, compared to $20,129 for those without serious illness.
Understanding Palliative Care and Depression’s Impact
The study defined serious illness as a life-limiting condition that reduces quality of life or imposes significant demands on caregivers. Palliative care, as described by the authors, seeks to alleviate pain, manage psychological symptoms, support physical function, and provide caregiver assistance.
Notably, depression emerged as the strongest predictor of higher health care use and cost.
“Among the four characteristics that we looked at, depression had the highest significance when it comes to association with health care utilization and costs,” Dr. Wong said. “If you were to choose any target to treat, it should be depression.”
Patients with both serious illness and depression were especially prone to increased hospital visits and expenditures.
A Call for Palliative Integration in Surgery
The study’s authors advocate for a shift toward integrating palliative care practices in surgical care, especially for routine elective operations among older, seriously ill adults.
While some propose embedding palliative care specialists in surgical teams, Dr. Wong noted a more scalable solution would involve training surgeons to recognize and address palliative needs.
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