Frailty and associated healthcare expenditures among patients undergoing total hip and knee arthroplasty

被引：0

作者：

Ron, Donna ^{[1
,2
,3
,4
]}

Daley, Alton B. ^{[2
,5
]}

Coe, Marcus P. ^{[2
,5
]}

Herrick, Michael D. ^{[2
,6
]}

Roth, Robert H. ^{[2
,6
]}

Abess, Alexander T. ^{[2
,6
]}

Martinez-Camblor, Pablo ^{[2
,6
,7
]}

Deiner, Stacie G. ^{[2
,6
]}

Boone, Myles D. ^{[2
,6
,8
]}

机构：

[1] Dartmouth Hitchcock Med Ctr, Dept Community & Family Med, Lebanon, NH USA

[2] Geisel Sch Med Dartmouth, Hanover, NH USA

[3] Meir Med Ctr, Dept Anesthesiol Crit Care & Pain Med, 59 Tchernichovsky St, IL-4428164 Kefar Sava, Israel

[4] Tel Aviv Univ, 59 Tchernichovsky St, IL-4428164 Kefar Sava, Israel

[5] Dartmouth Hitchcock Med Ctr, Dept Orthopaed Surg, Lebanon, NH USA

[6] Dartmouth Hitchcock Med Ctr, Dept Anesthesiol & Perioperat Med, Lebanon, NH USA

[7] Geisel Sch Med Dartmouth, Dept Biomed Data Sci, Hanover, NH USA

[8] Dartmouth Hitchcock Med Ctr, Dept Neurol, Lebanon, NH USA

来源：

JOURNAL OF FRAILTY & AGING | 2025年 / 14卷 / 02期

关键词：

Frailty; Health expenditures; Arthroplasty; Medicare; OUTCOMES; SERVICE;

D O I：

10.1016/j.tjfa.2025.100030

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

Background: Major joint surgery is one of the largest components of Medicare spending in the US and the most frequent major procedure performed in older adults. Increasing age is associated with increasing prevalence of frailty, but the influence of frailty on healthcare expenditures following arthroplasty has yet to be adequately explored. Objective: To explore the association between frailty and healthcare expenditures in the year following total hip and knee arthroplasties. Design:Retrospective cohort study Setting: United States population Participants: Medicare beneficiaries 65 and older undergoing total knee or hip arthroplasty ( n = 1,152,872) from 2017 through 2018. Measurements: Claims-based frailty index (exposure), total 1-year Medicare expenditures broken down by category (primary outcome), in-hospital complications, length of stay, discharge destination, readmission and mortality (secondary outcomes). Results: Among 435,496 patients who underwent hip (37.8 %) and 717,376 patients who underwent knee arthroplasty (62.2 %), the mean age was 73.7 years and 19.2 % were classified as frail. Median total expenditures in US dollars at one year were higher in those with frailty ($247,503; IQR [$169,400-$391,176]) relative to the prefrail ($179,379 [$127,396-$265,039]) and robust ($130,314 [$85,438-$199,605]) groups. Total expenditures included the index surgical admission, rehospitalization, skilled nursing care, and outpatient care, all of which were higher with increasing frailty. However, the surgical procedure accounted for less than a third of the total 1-year healthcare costs and was the category with the lowest degree of variation between patients. Frailty was also associated with longer lengths of stay, higher risks of complications, readmission, and mortality and lower likelihood of being discharged home after the procedure. Conclusions: Among older adults undergoing total hip and knee arthroplasty, frailty is associated with higher healthcare expenditures, predominantly driven by longitudinal care during the year following the procedure. More research is needed to test interventions to improve outcomes and reduce cost in this high-risk population.

引用

页数：8

共 42 条

[1] Berlin N.L., Kirch M., Singer D.C., Solway E., Malani P.N., Kullgren J.T., Preoperative concerns of older US adults and decisions about elective surgery, JAMA Netw Open, 7, 1, (2024)
[2] Fisher E.S., Bell J.E., Tomek I.M., Esty A.R., Goodman D.C., Trends and regional variation in hip, knee, and shoulder replacement: a dartmouth atlas surgery report, (2010)
[3] Cram P., Lu X., Kates S.L., Singh J.A., Li Y., Wolf B.R., Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991–2010, JAMA, 308, 12, pp. 1227-1236, (2012)
[4] Maradit Kremers H., Larson D.R., Crowson C.S., Et al., Prevalence of total hip and knee replacement in the United States, J Bone Joint Surg Am, 97, 17, pp. 1386-1397, (2015)
[5] Fried L.P., Cohen A.A., Xue Q.L., Walston J., Bandeen-Roche K., Varadhan R., The physical frailty syndrome as a transition from homeostatic symphony to cacophony, Nat Aging, 1, 1, pp. 36-46, (2021)
[6] Wang H.T., Fafard J., Ahern S., Vendittoli P.A., Hebert P., Frailty as a predictor of hospital length of stay after elective total joint replacements in elderly patients, BMC Musculoskelet Disord, 19, (2018)
[7] Wilkes J.G., Evans J.L., Prato B.S., Hess S.A., MacGillivray D.C., Fitzgerald T.L., Frailty cost: economic impact of Frailty in the elective surgical patient, J Am Coll Surg, 228, 6, pp. 861-870, (2019)
[8] Mrdutt M.M., Papaconstantinou H.T., Robinson B.D., Bird E.T., Isbell C.L., Preoperative frailty and surgical outcomes across diverse surgical subspecialties in a large health care system, J Am Coll Surg, 228, 4, pp. 482-490, (2019)
[9] Rothenberg K.A., Stern J.R., George E.L., Et al., Association of frailty and postoperative complications with unplanned readmissions after elective outpatient surgery, JAMA Netw Open, 2, 5, (2019)
[10] Khanna A.K., Motamedi V., Bouldin B., Et al., Automated electronic frailty index-identified frailty status and associated postsurgical adverse events, JAMA Netw Open, 6, 11, (2023)

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