Integrated postoperative care model for older colorectal surgery patients improves outcomes and reduces healthcare costs
Background Older surgical patients have an increased risk for postoperative complications, driving up healthcare costs. We determined if postoperative co‐management of older surgery patients is associated with postoperative outcomes and hospital costs. Methods Retrospective data were collected for p...
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| Veröffentlicht in: | Journal of the American Geriatrics Society (JAGS) 2023-05, Vol.71 (5), p.1452-1461 |
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| creator | Cizginer, Sevdenur Prohl, Eian G. Monteiro, Joao Filipe G. Yildiz, Ferhat Jones, Richard N. Schechter, Steven Patterson, Robert Klipfel, Adam Katlic, Mark Richard Daiello, Lori A. Mujahid, Nadia Neupane, Iva Cioffi, William G. Ducharme, Maria Vrees, Matthew D. McNicoll, Lynn |
| description | Background
Older surgical patients have an increased risk for postoperative complications, driving up healthcare costs. We determined if postoperative co‐management of older surgery patients is associated with postoperative outcomes and hospital costs.
Methods
Retrospective data were collected for patients ≥70 years old undergoing colorectal surgery at a community teaching hospital. Patient outcomes were compared between those receiving postoperative surgery co‐management care through the Optimization of Senior Care and Recovery (OSCAR) program and controls who received standard of care. Main outcome measures were postoperative complications and hospital charges, 30‐day readmission rate, length of stay (LOS), and transfer to intensive care during hospitalization. Multivariable linear regression was used to model total charge and multivariable logistic regression to model complications, adjusted for multiple variables (e.g., age, sex, race, body mass index, Charlson Comorbidity Index [CCI], American Society of Anesthesiologists score, surgery duration).
Results
All 187 patients in the OSCAR and control groups had a similar mean CCI score of 2.7 (p = 0.95). Compared to the control group, OSCAR recipients experienced less postoperative delirium (17% vs. 8%; p = 0.05), cardiac arrhythmia (12% vs. 3%; p = 0.03), and clinical worsening requiring transfer to intensive care (20% vs. 6%; p |
| doi_str_mv | 10.1111/jgs.18216 |
| format | Article |
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Older surgical patients have an increased risk for postoperative complications, driving up healthcare costs. We determined if postoperative co‐management of older surgery patients is associated with postoperative outcomes and hospital costs.
Methods
Retrospective data were collected for patients ≥70 years old undergoing colorectal surgery at a community teaching hospital. Patient outcomes were compared between those receiving postoperative surgery co‐management care through the Optimization of Senior Care and Recovery (OSCAR) program and controls who received standard of care. Main outcome measures were postoperative complications and hospital charges, 30‐day readmission rate, length of stay (LOS), and transfer to intensive care during hospitalization. Multivariable linear regression was used to model total charge and multivariable logistic regression to model complications, adjusted for multiple variables (e.g., age, sex, race, body mass index, Charlson Comorbidity Index [CCI], American Society of Anesthesiologists score, surgery duration).
Results
All 187 patients in the OSCAR and control groups had a similar mean CCI score of 2.7 (p = 0.95). Compared to the control group, OSCAR recipients experienced less postoperative delirium (17% vs. 8%; p = 0.05), cardiac arrhythmia (12% vs. 3%; p = 0.03), and clinical worsening requiring transfer to intensive care (20% vs. 6%; p < 0.005). OSCAR group patients had a shorter mean LOS among high‐risk patients (CCI ≥3) (−1.8 days; p = 0.09) and those ≥80 years old (−2.3 days; p = 0.07) compared to the control group. Mean total hospital charge was $10,297 less per patient in the OSCAR group (p = 0.01), with $17,832 less per patient with CCI ≥3 (p = 0.01), than the control group.
Conclusions
A co‐management care approach after colorectal surgery in older patients improves outcomes and decreases costs, with the most benefit going to the oldest patients and those with higher comorbidity scores.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/jgs.18216</identifier><identifier>PMID: 36721263</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Aged ; Aged, 80 and over ; Arrhythmia ; Body mass index ; Colorectal Surgery ; Comorbidity ; Complications ; co‐management model ; Elder care ; geriatric care ; Health care ; Health Care Costs ; Hospital costs ; Humans ; Intensive care ; Length of Stay ; Patients ; Postoperative ; Postoperative Care ; postoperative complications ; Postoperative Complications - etiology ; Retrospective Studies ; Surgery</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2023-05, Vol.71 (5), p.1452-1461</ispartof><rights>2023 The American Geriatrics Society.</rights><rights>2023 American Geriatrics Society and Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3536-e51e6f1d6fad0d0c1901bb22b97d539cb655780bf7f1d39f30e3af3b56c5c2c83</citedby><cites>FETCH-LOGICAL-c3536-e51e6f1d6fad0d0c1901bb22b97d539cb655780bf7f1d39f30e3af3b56c5c2c83</cites><orcidid>0000-0002-7134-7875 ; 0000-0002-1049-218X ; 0000-0003-1182-8578 ; 0000-0001-8374-8521 ; 0000-0001-8892-0466 ; 0000-0001-6233-8400 ; 0000-0003-3159-8597 ; 0000-0002-4830-1879 ; 0000-0002-5130-1909 ; 0000-0003-2991-0924 ; 0000-0001-9255-6521</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgs.18216$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgs.18216$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,782,786,1419,27931,27932,45581,45582</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36721263$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cizginer, Sevdenur</creatorcontrib><creatorcontrib>Prohl, Eian G.</creatorcontrib><creatorcontrib>Monteiro, Joao Filipe G.</creatorcontrib><creatorcontrib>Yildiz, Ferhat</creatorcontrib><creatorcontrib>Jones, Richard N.</creatorcontrib><creatorcontrib>Schechter, Steven</creatorcontrib><creatorcontrib>Patterson, Robert</creatorcontrib><creatorcontrib>Klipfel, Adam</creatorcontrib><creatorcontrib>Katlic, Mark Richard</creatorcontrib><creatorcontrib>Daiello, Lori A.</creatorcontrib><creatorcontrib>Mujahid, Nadia</creatorcontrib><creatorcontrib>Neupane, Iva</creatorcontrib><creatorcontrib>Cioffi, William G.</creatorcontrib><creatorcontrib>Ducharme, Maria</creatorcontrib><creatorcontrib>Vrees, Matthew D.</creatorcontrib><creatorcontrib>McNicoll, Lynn</creatorcontrib><title>Integrated postoperative care model for older colorectal surgery patients improves outcomes and reduces healthcare costs</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>Background
Older surgical patients have an increased risk for postoperative complications, driving up healthcare costs. We determined if postoperative co‐management of older surgery patients is associated with postoperative outcomes and hospital costs.
Methods
Retrospective data were collected for patients ≥70 years old undergoing colorectal surgery at a community teaching hospital. Patient outcomes were compared between those receiving postoperative surgery co‐management care through the Optimization of Senior Care and Recovery (OSCAR) program and controls who received standard of care. Main outcome measures were postoperative complications and hospital charges, 30‐day readmission rate, length of stay (LOS), and transfer to intensive care during hospitalization. Multivariable linear regression was used to model total charge and multivariable logistic regression to model complications, adjusted for multiple variables (e.g., age, sex, race, body mass index, Charlson Comorbidity Index [CCI], American Society of Anesthesiologists score, surgery duration).
Results
All 187 patients in the OSCAR and control groups had a similar mean CCI score of 2.7 (p = 0.95). Compared to the control group, OSCAR recipients experienced less postoperative delirium (17% vs. 8%; p = 0.05), cardiac arrhythmia (12% vs. 3%; p = 0.03), and clinical worsening requiring transfer to intensive care (20% vs. 6%; p < 0.005). OSCAR group patients had a shorter mean LOS among high‐risk patients (CCI ≥3) (−1.8 days; p = 0.09) and those ≥80 years old (−2.3 days; p = 0.07) compared to the control group. Mean total hospital charge was $10,297 less per patient in the OSCAR group (p = 0.01), with $17,832 less per patient with CCI ≥3 (p = 0.01), than the control group.
Conclusions
A co‐management care approach after colorectal surgery in older patients improves outcomes and decreases costs, with the most benefit going to the oldest patients and those with higher comorbidity scores.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arrhythmia</subject><subject>Body mass index</subject><subject>Colorectal Surgery</subject><subject>Comorbidity</subject><subject>Complications</subject><subject>co‐management model</subject><subject>Elder care</subject><subject>geriatric care</subject><subject>Health care</subject><subject>Health Care Costs</subject><subject>Hospital costs</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Length of Stay</subject><subject>Patients</subject><subject>Postoperative</subject><subject>Postoperative Care</subject><subject>postoperative complications</subject><subject>Postoperative Complications - etiology</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kcFO3DAQhq0KVLa0h75AZYkLPWTx2NhJjhWCBYTEAXq2HHuyZOXEqZ1A9-1xWegBCV9mRvr0eTQ_Id-BLSG_k806LaHioD6RBUjBC3kKco8sGGO8qBScHpAvKW0YA86q6jM5EKrkwJVYkL9Xw4TraCZ0dAxpCiPmoXtEak1E2geHnrYh0uAdRmqDDxHtZDxNc1xj3NIx4zhMiXb9GMMjJhrmyYY-N2ZwNKKbbe4f0Pjp4UVq8z_pK9lvjU_47bUekt8X5_dnl8XN7erq7NdNYYUUqkAJqFpwqjWOOWahZtA0nDd16aSobaOkLCvWtGWGRN0KhsK0opHKSsttJQ7J8c6bl_szY5p03yWL3psBw5w0L0tQopZ1ndGjd-gmzHHI22leAUgoVSUy9XNH2RhSitjqMXa9iVsNTP-LQ-c49Escmf3xapybHt1_8u3-GTjZAU-dx-3HJn29utspnwE4dJaT</recordid><startdate>202305</startdate><enddate>202305</enddate><creator>Cizginer, Sevdenur</creator><creator>Prohl, Eian G.</creator><creator>Monteiro, Joao Filipe G.</creator><creator>Yildiz, Ferhat</creator><creator>Jones, Richard N.</creator><creator>Schechter, Steven</creator><creator>Patterson, Robert</creator><creator>Klipfel, Adam</creator><creator>Katlic, Mark Richard</creator><creator>Daiello, Lori A.</creator><creator>Mujahid, Nadia</creator><creator>Neupane, Iva</creator><creator>Cioffi, William G.</creator><creator>Ducharme, Maria</creator><creator>Vrees, Matthew D.</creator><creator>McNicoll, Lynn</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7134-7875</orcidid><orcidid>https://orcid.org/0000-0002-1049-218X</orcidid><orcidid>https://orcid.org/0000-0003-1182-8578</orcidid><orcidid>https://orcid.org/0000-0001-8374-8521</orcidid><orcidid>https://orcid.org/0000-0001-8892-0466</orcidid><orcidid>https://orcid.org/0000-0001-6233-8400</orcidid><orcidid>https://orcid.org/0000-0003-3159-8597</orcidid><orcidid>https://orcid.org/0000-0002-4830-1879</orcidid><orcidid>https://orcid.org/0000-0002-5130-1909</orcidid><orcidid>https://orcid.org/0000-0003-2991-0924</orcidid><orcidid>https://orcid.org/0000-0001-9255-6521</orcidid></search><sort><creationdate>202305</creationdate><title>Integrated postoperative care model for older colorectal surgery patients improves outcomes and reduces healthcare costs</title><author>Cizginer, Sevdenur ; Prohl, Eian G. ; Monteiro, Joao Filipe G. ; Yildiz, Ferhat ; Jones, Richard N. ; Schechter, Steven ; Patterson, Robert ; Klipfel, Adam ; Katlic, Mark Richard ; Daiello, Lori A. ; Mujahid, Nadia ; Neupane, Iva ; Cioffi, William G. ; Ducharme, Maria ; Vrees, Matthew D. ; McNicoll, Lynn</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3536-e51e6f1d6fad0d0c1901bb22b97d539cb655780bf7f1d39f30e3af3b56c5c2c83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arrhythmia</topic><topic>Body mass index</topic><topic>Colorectal Surgery</topic><topic>Comorbidity</topic><topic>Complications</topic><topic>co‐management model</topic><topic>Elder care</topic><topic>geriatric care</topic><topic>Health care</topic><topic>Health Care Costs</topic><topic>Hospital costs</topic><topic>Humans</topic><topic>Intensive care</topic><topic>Length of Stay</topic><topic>Patients</topic><topic>Postoperative</topic><topic>Postoperative Care</topic><topic>postoperative complications</topic><topic>Postoperative Complications - etiology</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cizginer, Sevdenur</creatorcontrib><creatorcontrib>Prohl, Eian G.</creatorcontrib><creatorcontrib>Monteiro, Joao Filipe G.</creatorcontrib><creatorcontrib>Yildiz, Ferhat</creatorcontrib><creatorcontrib>Jones, Richard N.</creatorcontrib><creatorcontrib>Schechter, Steven</creatorcontrib><creatorcontrib>Patterson, Robert</creatorcontrib><creatorcontrib>Klipfel, Adam</creatorcontrib><creatorcontrib>Katlic, Mark Richard</creatorcontrib><creatorcontrib>Daiello, Lori A.</creatorcontrib><creatorcontrib>Mujahid, Nadia</creatorcontrib><creatorcontrib>Neupane, Iva</creatorcontrib><creatorcontrib>Cioffi, William G.</creatorcontrib><creatorcontrib>Ducharme, Maria</creatorcontrib><creatorcontrib>Vrees, Matthew D.</creatorcontrib><creatorcontrib>McNicoll, Lynn</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cizginer, Sevdenur</au><au>Prohl, Eian G.</au><au>Monteiro, Joao Filipe G.</au><au>Yildiz, Ferhat</au><au>Jones, Richard N.</au><au>Schechter, Steven</au><au>Patterson, Robert</au><au>Klipfel, Adam</au><au>Katlic, Mark Richard</au><au>Daiello, Lori A.</au><au>Mujahid, Nadia</au><au>Neupane, Iva</au><au>Cioffi, William G.</au><au>Ducharme, Maria</au><au>Vrees, Matthew D.</au><au>McNicoll, Lynn</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Integrated postoperative care model for older colorectal surgery patients improves outcomes and reduces healthcare costs</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2023-05</date><risdate>2023</risdate><volume>71</volume><issue>5</issue><spage>1452</spage><epage>1461</epage><pages>1452-1461</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><abstract>Background
Older surgical patients have an increased risk for postoperative complications, driving up healthcare costs. We determined if postoperative co‐management of older surgery patients is associated with postoperative outcomes and hospital costs.
Methods
Retrospective data were collected for patients ≥70 years old undergoing colorectal surgery at a community teaching hospital. Patient outcomes were compared between those receiving postoperative surgery co‐management care through the Optimization of Senior Care and Recovery (OSCAR) program and controls who received standard of care. Main outcome measures were postoperative complications and hospital charges, 30‐day readmission rate, length of stay (LOS), and transfer to intensive care during hospitalization. Multivariable linear regression was used to model total charge and multivariable logistic regression to model complications, adjusted for multiple variables (e.g., age, sex, race, body mass index, Charlson Comorbidity Index [CCI], American Society of Anesthesiologists score, surgery duration).
Results
All 187 patients in the OSCAR and control groups had a similar mean CCI score of 2.7 (p = 0.95). Compared to the control group, OSCAR recipients experienced less postoperative delirium (17% vs. 8%; p = 0.05), cardiac arrhythmia (12% vs. 3%; p = 0.03), and clinical worsening requiring transfer to intensive care (20% vs. 6%; p < 0.005). OSCAR group patients had a shorter mean LOS among high‐risk patients (CCI ≥3) (−1.8 days; p = 0.09) and those ≥80 years old (−2.3 days; p = 0.07) compared to the control group. Mean total hospital charge was $10,297 less per patient in the OSCAR group (p = 0.01), with $17,832 less per patient with CCI ≥3 (p = 0.01), than the control group.
Conclusions
A co‐management care approach after colorectal surgery in older patients improves outcomes and decreases costs, with the most benefit going to the oldest patients and those with higher comorbidity scores.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>36721263</pmid><doi>10.1111/jgs.18216</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-7134-7875</orcidid><orcidid>https://orcid.org/0000-0002-1049-218X</orcidid><orcidid>https://orcid.org/0000-0003-1182-8578</orcidid><orcidid>https://orcid.org/0000-0001-8374-8521</orcidid><orcidid>https://orcid.org/0000-0001-8892-0466</orcidid><orcidid>https://orcid.org/0000-0001-6233-8400</orcidid><orcidid>https://orcid.org/0000-0003-3159-8597</orcidid><orcidid>https://orcid.org/0000-0002-4830-1879</orcidid><orcidid>https://orcid.org/0000-0002-5130-1909</orcidid><orcidid>https://orcid.org/0000-0003-2991-0924</orcidid><orcidid>https://orcid.org/0000-0001-9255-6521</orcidid></addata></record> |
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| ispartof | Journal of the American Geriatrics Society (JAGS), 2023-05, Vol.71 (5), p.1452-1461 |
| issn | 0002-8614 1532-5415 |
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| source | MEDLINE; Access via Wiley Online Library |
| subjects | Aged Aged, 80 and over Arrhythmia Body mass index Colorectal Surgery Comorbidity Complications co‐management model Elder care geriatric care Health care Health Care Costs Hospital costs Humans Intensive care Length of Stay Patients Postoperative Postoperative Care postoperative complications Postoperative Complications - etiology Retrospective Studies Surgery |
| title | Integrated postoperative care model for older colorectal surgery patients improves outcomes and reduces healthcare costs |
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