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 preoperative 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 (age 66 years or older) with and without serious illness who underwent major elective surgery between 2007 and 2019. Exposures included serious illness and pain, depression, functional dependence, and care partner needs before operation. Outcomes were 1-year healthcare usage and cost (ie total hospital days, hospital readmission, emergency department visits, and Medicare cost). 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 preoperative palliative care needs experienced a higher rate of total hospital days (incidence rate ratio [IRR] 2.0, 95% CI 1.5 to 2.6), hospital readmission (IRR 2.0, 95% CI 1.6 to 2.4) and emergency department visits (IRR 1.9, 95% CI 1.6 to 2.3). Adjusted 1-year healthcare cost was significantly higher among seriously ill older adults with these palliative care needs compared with those without serious illness (mean [SE] cost $38,187 [2,291] vs $20,129 [1,742]). CONCLUSIONS: Seriously ill older adults undergoing major elective surgery had a high prevalence of palliative care needs, which were associated with increased healthcare usage and cost. These findings highlight the imperative to identify and intervene in older surgical patients who may benefit from palliative care.