Prevalence of Preoperative Palliative Care Needs and Association with Healthcare Use and Cost Among Older Adults Undergoing Major Elective Surgery.

Background: Seriously ill older surgical patients with pre-operative palliative care needs, such as those with pain, depression, functional dependence, and care partner needs may benefit from palliative care but their prevalence, characteristics, and outcomes have not been described.

Study design: We used data from the Health and Retirement Survey linked to Medicare Claims and included older adults (≥66 years) with and without serious illness who underwent major elective surgery between 2007 to 2019. Exposures included serious illness and pain, depression, functional dependence, and care partner needs before surgery. Outcomes were one-year healthcare utilization and costs (i.e., total hospital days, hospital readmissions, emergency department visits, and Medicare costs).

Results: Among 2,499 older adults undergoing major elective surgery, 63% were seriously ill, and 79% reported pain, depression, functional dependence, or care partner needs. Seriously ill older adults with pre-operative palliative care needs experienced higher rates of total hospital days (Incidence Rate Ratio, IRR 2.0, 95% CI 1.5-2.6), hospital readmissions (IRR 2.0, 95% CI 1.6-2.4) and emergency department visits (IRR 1.9, 95% CI 1.6-2.3). Adjusted one-year healthcare costs were significantly higher among seriously ill older adults with these palliative care needs compared to those without serious illness (mean [SE] cost $38,187 [2,291] vs $20,129 [1,742]).

Conclusion: Seriously ill older adults undergoing major elective surgery had a high prevalence of palliative care needs which were associated with increased healthcare utilization and costs. These findings highlight the imperative to identify and intervene in older surgical patients who may benefit from palliative care.