Economic Burden of Postoperative Neurocognitive Disorders Among US Medicare Patients

Key Points Question What is the association of patients who are diagnosed with a postoperative neurocognitive disorder with total Medicare health care expenditures in the year after their surgical procedure? Findings In this retrospective cohort study including nearly 2.4 million Medicare patients, after adjusting for patient and hospital characteristics, the presence of a postoperative neurocognitive disorder was associated with an increase of $17 275 in payments in the 1 year after the index surgical procedure. Meaning These findings suggest that in older patients who underwent surgical treatment, a diagnosis of a postoperative neurocognitive disorder was associated with an increase in health care costs for up to 1 year after treatment, emphasizing the economic burden associated with this potentially modifiable complication.
This cohort study examined the association of postoperative neurocognitive disorders with health care expenditures among US Medicare patients.
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