Economic Burden of Postoperative Neurocognitive Disorders Among US Medicare Patients.

ABSTRACT: Importance:Postoperative neurocognitive disorders (PNDs) after surgical procedures are common and may be associated with increased health care expenditures. Objective:To quantify the economic burden associated with a PND diagnosis in 1 year following surgical treatment among older patients in the United States. Design, Setting, and Participants:This retrospective cohort study used claims data from the Bundled Payments for Care Improvement Advanced Model from 4285 hospitals that submitted Medicare Fee-for-service (FFS) claims between January 2013 and December 2016. All Medicare patients aged 65 years or older who underwent an inpatient hospital admission associated with a surgical procedure, did not experience a PND before index admission, and were not undergoing dialysis or concurrently enrolled in Medicaid were included. Data were analyzed from October 2019 and May 2020. Exposures:PND, defined as an International Classification of Diseases, Ninth or Tenth Revision, diagnosis of delirium, mild cognitive impairment, or dementia within 1 year of discharge from the index surgical admission. Main Outcomes and Measures:The primary outcome was total inflation-adjusted Medicare postacute care payments within 1 year after the index surgical procedure. Results:A total of 2?380?473 patients (mean [SD] age, 75.36 (7.31) years; 1?336?736 [56.1%] women) who underwent surgical procedures were included, of whom 44?974 patients (1.9%) were diagnosed with a PND. Among all patients, most were White (2?142?157 patients [90.0%]), presenting for orthopedic surgery (1?523?782 patients [64.0%]) in urban medical centers (2?179?893 patients [91.6%]) that were private nonprofits (1?798?749 patients [75.6%]). Patients with a PND, compared with those without a PND, experienced a significantly longer hospital length of stay (mean [SD], 5.91 [6.01] days vs 4.29 [4.18] days; P?

SUBMITTER: Boone MD 

PROVIDER: S-EPMC7395237 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature