The Hidden Costs of Elective Surgeries for Older Adults with Serious Illnesses

Understanding the Impact of Elective Surgeries on Older Adults

For older adults with serious pre-existing conditions, elective surgeries can lead to extended hospital stays, increased healthcare visits, and significantly higher medical expenses. These findings, published in the Journal of the American College of Surgeons, underscore the challenging landscape these patients navigate when seeking surgical interventions.

Key Findings from the Study

Researchers analyzed data from 2,499 patients aged 66 and older who underwent major elective surgeries between 2007 and 2019. This study utilized data from the Health and Retirement Survey linked to Medicare claims. The results reveal some concerning trends:

– Older adults with serious illnesses had hospital stays twice as long as their peers without such conditions.
– They were twice as likely to return to the hospital or emergency department post-surgery.
– Their annual healthcare costs were nearly double compared to those without serious illnesses.

The Role of Palliative Care

Dr. Jolene Wong Si Min, the lead author from Brigham and Women’s Hospital in Boston and the National Cancer Center Singapore, emphasized the high palliative care needs among this group. The study identified four key clinical characteristics indicating a need for palliative care before surgery: moderate to severe pain, depression, functional dependence, and a need for a care partner. Approximately 79% of the study population exhibited one or more of these characteristics.

Depression: A Critical Target for Intervention

Among the identified characteristics, depression was notably associated with increased healthcare utilization and costs. Dr. Wong suggests that targeting depression could be a crucial intervention point to alleviate some of the burdens faced by these patients. Patients with serious illnesses and depression were found to have significantly higher rates of healthcare use than those without depression.

Future Directions in Surgical and Palliative Care

Dr. Wong and her colleagues propose a more integrated approach to managing the needs of seriously ill patients undergoing elective surgeries. While some advocate embedding palliative care specialists within surgical teams, the study authors suggest training surgeons to address palliative care needs could be more practical and effective. This approach aligns with a generalist palliative care model, where surgeons are equipped to understand and apply palliative care principles in their practice.

Collaborative Efforts for Better Outcomes

The study’s senior author, Dr. Zara Cooper, along with co-authors including Yihan Wang, PhD, and others, highlight the need for ongoing research to refine these integrative practices. They advocate for a healthcare model where the intersection of surgical and palliative care is more pronounced, ultimately improving outcomes for older adults with serious illnesses.

By addressing the unique needs of these patients, healthcare providers can help mitigate the substantial burdens associated with elective surgeries, ensuring a higher quality of life and reduced healthcare costs for this vulnerable population. The study calls for a shift in how surgical care is delivered, emphasizing the importance of palliative considerations in routine surgical procedures.