Post-Surgical Delirium Among Older Adults After Elective Procedures Cost Nearly $60k Per Patient, Each Year: Study

The findings of a new study highlight the impact of post-surgical delirium, which is a surprisingly common and serious complication among older individuals, and results in significant additional health care costs.

Postoperative delirium care can exceed $50,000 per patient, in addition to other health care costs associated with the underlying treatment, according to the findings published by Harvard and Brigham and Women’s Hospital researchers in the journal JAMA Surgery.

Researchers conducted a study evaluating data on 500 older adults undergoing major elective surgery between June 2010 and August 2013, from the Successful Aging after Elective Surgery (SAGES) study. Patients were 70 years or older and scheduled to undergo major surgery at one of two Harvard-affiliated hospitals with an anticipated length of stay of at least three days.

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Eligible surgical procedures included total hip or knee replacement, lumbar, cervical, or sacral laminectomy, lower extremity arterial bypass surgery, open abdominal aortic aneurysm repair and open or laparoscopic colectomy.

Over the course of the study, 25% of patients developed postoperative delirium, and those patients had clearly higher health care costs than among the 75% of patients who did not experience the surgical complication. Costs for patients with surgical delirium reached up to $146,358 compared to $94,609 for the patients without delirium.

“Results suggest that incident delirium and severe delirium after elective surgery are associated with a high cost to the health care system, with substantial public health implications that warrant renewed efforts to bolster prevention, early detection, and management of delirium,” researchers wrote.

After adjusting for other factors, the cumulative health care costs attributable to delirium were $44,291 per patient per year. Most costs came from the first 90 days of care.

Costs increased based on the level of severity. Care for patients without delirium or mild delirium averaged $83,000 but care for patients with severe delirium averaged $140,000.

Postoperative delirium is a common, but serious and potentially preventable problem for older adults. It has been linked to poor hospital outcomes, prolonged hospital stays, functional and cognitive decline, and increased death rates. It is the most common postoperative complication for older adults and can be caused by the drugs used during surgery like sedatives and anesthesia, infection, electrolyte imbalance, and side effects form immobilization.

While the costs of delirium can average from $44,000 to $56,000 per patient per year depending on the severity, nationally, the health care costs attributable to post-operative delirium are estimated at $33 billion per year.

“These findings suggest that the economic outcomes of delirium and severe delirium after elective surgery are substantial, rivaling costs associated with cardiovascular disease and diabetes,” wrote study authors. “These results highlight the need for policy imperatives to address delirium as a large-scale public health issue.”

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