BACKGROUND: Rapid growth in the older demographic and concomitant increased prevalence of cardiovascular disease and frailty have been linked to health care cost drivers including prolonged hospital length of stay, increased mortality, major morbidity, loss of independence and decline in overall quality of life. Costs associated with pre-operative frailty in patients referred for cardiovascular surgery have yet to be studied.
METHODS AND RESULTS: A prospective cohort study of patients ≥50 years of age referred for planned or urgent cardiac surgery between 2011-2014 in Alberta were screened for pre-operative frailty using the Clinical Frailty Scale (CFS). Vital status, health services use and costs, including inpatient, outpatient, emergency department, practitioner claims, supportive living and long term care, were analyzed for the year prior to surgery to ≤7 years postoperatively. Annual costs were compared between patients screened as frail and non-frail over time. The cohort (n=529) mean age (SD) was 67 (±9) years, 26% were female, with prevalence of frailty 10% (n = 51, CFS ≥5). Compared to nonfrail patients, those screened frail had higher median (IQR) overall costs ($387,360 [$187,254 - $613,684] vs. $178,860 [$136,779 - $265,611], p < 0.001). The median (IQR) cost of all services in the year prior to surgery was higher for frail patients compared to nonfrail ($12,708 [$7,775 - $18,852] vs. $7,642 [$5,802 - $11,513], p < 0.001. Health services median (IQR) cost during the surgical hospital stay and one year following for patients screened as frail was $200,709 ($146,177 - $486,852), compared to $147,730 ($100,674 - $177,025) in nonfrail patients (p < 0.001).
CONCLUSION: Using a validated measure of frailty, pre-operative frailty was found in 1 in 10 cardiac surgery patients and was associated with disproportionate health services cost. Clinicians and administrators may benefit from the addition of frailty screening to cardiac surgery programs. Knowledge of frailty status may support the design of novel interventions and contribute to health resource planning to address the costly needs of this vulnerable population.