How comorbidities and preoperative expenditures correlate with postoperative adverse outcomes

Chih-Hsiung Wu, Ruei-Ming Chen, Hsiao Chien Tsai, Chuen-Chau Chang, Hang Chang, Chien-Chang Liao, Ta-Liang Chen

研究成果: 雜誌貢獻文章

4 引文 (Scopus)

摘要

Objectives: To examine the correlation of preexisting illnesses and preoperative medical expenditures with postoperative major adverse outcomes among geriatric surgical patients. Study Design: Retrospective cohort study using claims from Taiwan's National Health Insurance Research Database. Methods: All geriatric patients aged ≥65 years receiving inpatient surgeries during 2004 to 2007 under universal healthcare coverage were included. Surgical patients aged 55 to 64 years were the reference group. Risk-adjusted 30-day postoperative complication and mortality rates among elderly patients in various age sectors were analyzed and correlated with the preexisting illnesses and preoperative medical expenditures quantitatively. Results: Among 432,614 elderly surgical patients in specific age sectors and 238,802 controls, the prevalence of preexisting illnesses and the riskadjusted postoperative adverse outcome rates were highly age dependent and illness related. When comparing patients aged ≥85 years with patients aged 55 to 64 years, the adjusted odds ratios were 2.74 (95% confidence interval [CI], 2.67-2.82) and 3.56 (95% CI 3.31 -3.84) for incidence of major postoperative complications and mortality after major complications, respectively. Numbers of preexisting illnesses increased in an age-dependent pattern and the preoperative 24-month medical expenditures increased incrementally with the numbers of comorbidities. Postoperative major complications, but not mortality rates, were highly correlated with the numbers of comorbidities and increased parallel with preoperative 24-month comorbidity-related medical expenditures, especially in the younger age group. Conclusions: Adjusting for preexisting covariates, geriatric patients had an age-dependent, illnessrelated, and expenditure-associated pattern of higher postoperative complication and mortality rates. The numbers of comorbidities and preoperative medical expenditures had high predictive value for postoperative adverse outcomes.

原文英語
期刊American Journal of Managed Care
18
發行號11
出版狀態已發佈 - 十一月 2012

指紋

Health Expenditures
Comorbidity
Preexisting Condition Coverage
Geriatrics
Mortality
Universal Coverage
Confidence Intervals
National Health Programs
Taiwan
Inpatients
Cohort Studies
Retrospective Studies
Age Groups
Odds Ratio
Databases
Delivery of Health Care
Incidence
Research

ASJC Scopus subject areas

  • Health Policy

引用此文

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title = "How comorbidities and preoperative expenditures correlate with postoperative adverse outcomes",
abstract = "Objectives: To examine the correlation of preexisting illnesses and preoperative medical expenditures with postoperative major adverse outcomes among geriatric surgical patients. Study Design: Retrospective cohort study using claims from Taiwan's National Health Insurance Research Database. Methods: All geriatric patients aged ≥65 years receiving inpatient surgeries during 2004 to 2007 under universal healthcare coverage were included. Surgical patients aged 55 to 64 years were the reference group. Risk-adjusted 30-day postoperative complication and mortality rates among elderly patients in various age sectors were analyzed and correlated with the preexisting illnesses and preoperative medical expenditures quantitatively. Results: Among 432,614 elderly surgical patients in specific age sectors and 238,802 controls, the prevalence of preexisting illnesses and the riskadjusted postoperative adverse outcome rates were highly age dependent and illness related. When comparing patients aged ≥85 years with patients aged 55 to 64 years, the adjusted odds ratios were 2.74 (95{\%} confidence interval [CI], 2.67-2.82) and 3.56 (95{\%} CI 3.31 -3.84) for incidence of major postoperative complications and mortality after major complications, respectively. Numbers of preexisting illnesses increased in an age-dependent pattern and the preoperative 24-month medical expenditures increased incrementally with the numbers of comorbidities. Postoperative major complications, but not mortality rates, were highly correlated with the numbers of comorbidities and increased parallel with preoperative 24-month comorbidity-related medical expenditures, especially in the younger age group. Conclusions: Adjusting for preexisting covariates, geriatric patients had an age-dependent, illnessrelated, and expenditure-associated pattern of higher postoperative complication and mortality rates. The numbers of comorbidities and preoperative medical expenditures had high predictive value for postoperative adverse outcomes.",
author = "Chih-Hsiung Wu and Ruei-Ming Chen and Tsai, {Hsiao Chien} and Chuen-Chau Chang and Hang Chang and Chien-Chang Liao and Ta-Liang Chen",
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T1 - How comorbidities and preoperative expenditures correlate with postoperative adverse outcomes

AU - Wu, Chih-Hsiung

AU - Chen, Ruei-Ming

AU - Tsai, Hsiao Chien

AU - Chang, Chuen-Chau

AU - Chang, Hang

AU - Liao, Chien-Chang

AU - Chen, Ta-Liang

PY - 2012/11

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N2 - Objectives: To examine the correlation of preexisting illnesses and preoperative medical expenditures with postoperative major adverse outcomes among geriatric surgical patients. Study Design: Retrospective cohort study using claims from Taiwan's National Health Insurance Research Database. Methods: All geriatric patients aged ≥65 years receiving inpatient surgeries during 2004 to 2007 under universal healthcare coverage were included. Surgical patients aged 55 to 64 years were the reference group. Risk-adjusted 30-day postoperative complication and mortality rates among elderly patients in various age sectors were analyzed and correlated with the preexisting illnesses and preoperative medical expenditures quantitatively. Results: Among 432,614 elderly surgical patients in specific age sectors and 238,802 controls, the prevalence of preexisting illnesses and the riskadjusted postoperative adverse outcome rates were highly age dependent and illness related. When comparing patients aged ≥85 years with patients aged 55 to 64 years, the adjusted odds ratios were 2.74 (95% confidence interval [CI], 2.67-2.82) and 3.56 (95% CI 3.31 -3.84) for incidence of major postoperative complications and mortality after major complications, respectively. Numbers of preexisting illnesses increased in an age-dependent pattern and the preoperative 24-month medical expenditures increased incrementally with the numbers of comorbidities. Postoperative major complications, but not mortality rates, were highly correlated with the numbers of comorbidities and increased parallel with preoperative 24-month comorbidity-related medical expenditures, especially in the younger age group. Conclusions: Adjusting for preexisting covariates, geriatric patients had an age-dependent, illnessrelated, and expenditure-associated pattern of higher postoperative complication and mortality rates. The numbers of comorbidities and preoperative medical expenditures had high predictive value for postoperative adverse outcomes.

AB - Objectives: To examine the correlation of preexisting illnesses and preoperative medical expenditures with postoperative major adverse outcomes among geriatric surgical patients. Study Design: Retrospective cohort study using claims from Taiwan's National Health Insurance Research Database. Methods: All geriatric patients aged ≥65 years receiving inpatient surgeries during 2004 to 2007 under universal healthcare coverage were included. Surgical patients aged 55 to 64 years were the reference group. Risk-adjusted 30-day postoperative complication and mortality rates among elderly patients in various age sectors were analyzed and correlated with the preexisting illnesses and preoperative medical expenditures quantitatively. Results: Among 432,614 elderly surgical patients in specific age sectors and 238,802 controls, the prevalence of preexisting illnesses and the riskadjusted postoperative adverse outcome rates were highly age dependent and illness related. When comparing patients aged ≥85 years with patients aged 55 to 64 years, the adjusted odds ratios were 2.74 (95% confidence interval [CI], 2.67-2.82) and 3.56 (95% CI 3.31 -3.84) for incidence of major postoperative complications and mortality after major complications, respectively. Numbers of preexisting illnesses increased in an age-dependent pattern and the preoperative 24-month medical expenditures increased incrementally with the numbers of comorbidities. Postoperative major complications, but not mortality rates, were highly correlated with the numbers of comorbidities and increased parallel with preoperative 24-month comorbidity-related medical expenditures, especially in the younger age group. Conclusions: Adjusting for preexisting covariates, geriatric patients had an age-dependent, illnessrelated, and expenditure-associated pattern of higher postoperative complication and mortality rates. The numbers of comorbidities and preoperative medical expenditures had high predictive value for postoperative adverse outcomes.

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