Short-Term Outcomes and Cost Drivers of Emergency Surgery for Acute Abdominal Disease in Super-Elderly Patients: A Study in the Japanese Tertiary Care Hospital

Abstract

Background

Although emergency surgery for acute abdominal disease in super-elderly patients is often associated with high risk and substantial resource utilization, the relationship between short-term outcomes and inpatient medical costs remains unclear.

Methods

In total, 247 patients aged ≥ 85 years who underwent emergency surgery for acute abdominal disease were analyzed. Inpatient costs were assessed using total inpatient claim points and the fee-for-service component under Japan's diagnosis-based payment system. Multivariable analyses were performed to identify risk factors for postoperative complications, non-home discharge, and excess inpatient costs.

Results

Overall complications occurred in 44.1% of patients, major complications in 19.4%, and 72.1% were discharged home. Mortality was predominantly observed in strangulated bowel obstruction, bowel perforation, and gastrointestinal ischemia or bleeding (8.1%). Multivariable analyses identified American Society of Anesthesiologists physical status (odds ratio [OR] 3.52, p < 0.001) and operative time (OR 2.10, p < 0.001) as independent risk factors for major complications, while age (OR 1.17, p < 0.001), dementia (OR 2.34, p = 0.006), and major complications (OR 2.87, p = 0.005) were associated with non-home discharge. Total inpatient claim points were nearly doubled in patients with major complications (p < 0.001), and residual cost analysis demonstrated disproportionately high inpatient costs among patients without major complications, independent of length of stay.

Conclusions

Emergency abdominal surgery can be performed with acceptable short-term outcomes and high likelihood of discharge to home in carefully selected super-elderly patients. Inpatient costs among patients without major complications might be modifiable through optimization of perioperative management and resource utilization.