Integrated postoperative care model for older colorectal surgery patients improves outcomes and reduces healthcare costs

Background: Older surgical patients have an increased risk for postoperative complications, driving up healthcare costs. We determined if postoperative co-management of older surgery patients is associated with postoperative out -comes and hospital costs.Methods: Retrospective data were collected for patients > 70 years old undergoing colorectal surgery at a community teaching hospital. Patient outcomes were com-pared between those receiving postoperative surgery co-management care through the Optimization of Senior Care and Recovery (OSCAR) program and controls who received standard of care. Main outcome measures were postoperative complications and hospital charges, 30-day readmission rate, length of stay (LOS), and transfer to intensive care during hospitalization. Multivariable linear regression was used to model total charge and multivariable logistic regression to model complications, adjusted for multiple variables (e.g., age, sex, race, body mass index, Charlson Comor-bidity Index [CCI], American Society of Anesthesiologists score, surgery duration).Results: All 187 patients in the OSCAR and control groups had a similar mean CCI score of 2.7 (p = 0.95). Compared to the control group, OSCAR recipients experi-enced less postoperative delirium (17% vs. 8%; p = 0.05), cardiac arrhythmia (12% vs. 3%; p = 0.03), and clinical worsening requiring transfer to intensive care (20% vs. 6%; p < 0.005). OSCAR group patients had a shorter mean LOS among high-risk patients (CCI >= 3) (-1.8 days; p = 0.09) and those > 80 years old (-2.3 days; p = 0.07) compared to the control group. Mean total hospital charge was 10,297 less per patient in the OSCAR group (p = 0.01), with 17,832 less per patient with CCI >= 3 (p = 0.01), than the control group.