Seriously Ill Seniors Undergoing Major Elective Surgery Could Benefit from Palliative Care

Wong Si Min J, Wang Y, Bollens-Lund E, et al. Prevalence of Preoperative Palliative Care Needs and Associations with Healthcare Utilization and Costs Among Older Adults Undergoing Major Elective Surgery. J Am Coll Surg. 2025; in press.

In this longitudinal, nationally representative cohort study, Jolene Wong Si Min, from Brigham and Women’s Hospital in Boston, Massachusetts, and colleagues analyzed information linked to Medicare claims on 2,499 patients, aged 66 years and older, undergoing major elective surgery between 2007 and 2019.

They found that 63% of the patients were seriously ill before surgery, and 79% reported pre-palliative care needs such as pain, depression, functional dependence, or care partner needs.

In the presence of these characteristics, the seriously ill older adults experienced double the rate of complications, required longer ICU stay, and had longer lengths of hospitalization immediately after surgery. The trend for increased healthcare utilization persisted at 1 year, with a mean adjusted cost nearly double that of older patients without serious illness ($38K vs. $20K). The mean cost was even higher among patients with depression ($47K).

The authors said this study represents one of the first efforts to systematically characterize seriously ill older adults undergoing surgery and highlights the opportunity for palliative care to improve functional and psychosocial outcomes and potentially reduce unnecessary healthcare utilization and costs.