Age, resource consumption, and outcome for surgical patients at an academic medical center.

Abstract

Many changes are under way in the payment for physician and hospital care of the surgical patient. Relatively little data have been analyzed on resource consumption for hospitalized surgical patients. The purpose of this study was to characterize hospital resource consumption and outcome by age for surgical patients. All surgical admissions at a large academic medical center from Jan. 1, 1985, through March 31, 1986, were analyzed by means of the diagnostic related group (DRG) format. Total costs (exclusive of physician fees) for the 7341 surgical patients studied were $58,206,815. Mean cost per patient, length of stay, percent of outliers, and mortality increased with age. DRG case-mix index and the number of procedures per patient peaked at age 69 and then decreased. Emergency admission was high for the young (i.e., aged 18 to 24 years) and for very elderly patients (i.e., aged over 75 years). Blood transfusions increased steadily as the age of the patient increased; use of surgical intensive care units increased until age 64 years, then plateaued. This study demonstrated a number of trends in surgical patient age and use of resources. Under prospective payment systems (i.e., DRG reimbursement) financial risk increased with the age of the patient. Length of hospital stay and mortality increased with age; however, DRG case-mix index and the number of procedures per patient peaked at age 69, which suggests that elderly surgical patients (i.e., those above 70 years of age) may be more severely ill on average than younger patients.