Healthcare costs are increasing. Aging is associated with increased postoperative complications resulting in increased disability, cost and mortality. Elderly populations are growing as baby-boomers age; the cost of caring for them is rising. It is unclear how surgery contributes to costs. Understanding the costs of surgical care for the elderly is crucial for healthcare services planning. We hypothesized that increasing age predicted increasing surgical inpatient costs.
Retrospective analysis of general surgical inpatient costs over two fiscal years at four hospitals was performed. Cost and number of procedures were reported by age, procedure, hospital, cost category, and surgical urgency. Costs were compared between surgical risk profile, urgency and age. Cost differences of 10% or greater were considered clinically significant.
Surgical inpatient costs for 12,070 procedures, representing 84% of surgical admissions in the region, were examined. The average cost was $4,351 for scheduled admissions and $4,054 for unscheduled admissions. Only unscheduled admissions were significantly costlier in older age groups; cost increase is attributed to post-operative care. Overall, scheduled low risk procedures had costs that were statistically but not clinically significantly lower for both 65-79 (-8.8%, p<.001) and 80+ (-8.8%, p<.001) age groups and unchanged for moderate and high risk procedures. However, unscheduled cases were clinically significantly costlier for 65-79 (Low risk [48.1%, p<.001], moderate risk [36.8%. p=.045], high risk [22.6%. p=.04]) and 80+ (Low risk [115.3%, p<.001], moderate risk [103.3%. p<.001], high risk [46.0%. p<.001]) age groups when compared to those under 65. The predominant driver of cost was post-operative care.
Costs increased with age in emergency but not elective surgery. Low, moderate and high risk unscheduled surgery all result in higher cost in the elderly due to increased post-operative care costs. Screening elective surgical candidates may decrease admission costs and innovative programs are needed to reduce emergency admission costs.

Surgical cost increase with age in emergency but not elective general surgery