Econometric Analysis of Optimal Site of Care for Prefrail and Frail Patients Undergoing Mastectomy for Breast Cancer

Q: How is frailty measured in this analysis?

Frailty is defined using the Hospital Frailty Risk Score.

Q: What relationship does frailty have with the site of care?

Multivariable analysis shows frailty or prefrailty is associated with increased inpatient care.

Q: Do transfer rates from ASCs to acute care hospitals remain low for prefrail and frail patients?

Yes. Although transfer odds are higher among prefrail and frail patients, observed transfer rates remain low (below 0.4%).

Q: What are the cost implications of providing care in ASCs for prefrail and frail patients?

Expected costs are higher for prefrail and frail patients compared with robust patients, but if ASC transfer rates stay at current levels, average cost savings are estimated at $8,404 per patient.

Sep 28, 2026

Uploaded by Connor

Econometric analysis examines how frailty influences the site of care for breast cancer patients undergoing mastectomy, comparing ambulatory surgery centers (ASCs) with inpatient settings. Appropriateness of ASC use is described as inconsistently defined and partly driven by subjective clinician judgment, creating variability in practice. Using the AHRQ HCUP NIS and NASS datasets, frailty defined by the Hospital Frailty Risk Score is linked to higher inpatient care and higher transfer odds, though transfer rates remain low. Expected costs for frail/prefrail patients are higher, yet treating them in ASCs can still yield average cost savings.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Abstract

Data sources and outcomes

Key findings on inpatient care and transfer

Cost implications and practice recommendation

Innovation in Aging, 2025, Vol. 9, No. S2 1117 Abstract citation ID: igaf122.3751 ECONOMETRIC ANALYSIS OF OPTIMAL SITE OF CARE FOR PREFRAIL AND FRAIL PATIENTS UNDERGOING MASTECTOMY FOR BREAST CANCER Claire Morton1, Yu-Jen Chen2, Kenneth Williams2, Randall Bloch3, Ezra Brooks2, Christina Minami2, Zara Cooper2, and Louis Nguyen2, 1. Center for Surgery and Public Health, Boston, Massachusetts, United States, 2. Brigham and Women’s Hospital, Boston, Massachusetts, United States, 3. Boston Medical Center, Boston, Massachusetts, United States Patients with breast cancer undergo mastectomy in ambulatory surgery centers (ASCs) or inpatient settings, each considered safe for appropriate patients. Appropriateness remains poorly defined and relies on subjective clinician assessment contributing to variability in practice patterns that may be suboptimal. Utilizing theAHQR HCUP NIS and NASS, we sought to understand the association of frailty, defined by the Hospital Frailty Risk Score, with site of care. Secondary outcomes included transfer to an acute care hospital from an ASC and cost of care. 85.3% of all patients (190,148) and 51.3%(2,603) of prefrail or frail patients underwent surgery in ASCs. On multivariable analysis, 1118 Innovation in Aging, 2025, Vol. 9, No. S2 frailty or prefrailty (OR 5.856) was associated with increased inpatient care (p < 0.001) . Rates of transfer were low (0.1%) . Odds of transfer were higher among prefrail and frail patients (OR 2.640, p < 0.05) but rates remained low (< 0.4%) . Given clinician sorting, expected costs of mastectomy for prefrail and frail patients were greater than those for robust patients ($56,036 .23, SE $396 .05, vs $49,929 .62, SE: $142 . 89) . We calculate that rates of transfer that would negate cost savings associated with ambulatory procedures is over 100 times the currently observed rate (38%, SE 4.7%). If all prefrail and frail patients received care atASCs with transfer rates at currently observed levels expected cost savings would average $8,404 per patient. Our findings suggest that despite slightly higher rates of transfer to an acute care hospital following ASC care, clinicians should consider treating frail and prefrail older adults in ASCs more often.

FAQs

How is frailty measured in this analysis?

Frailty is defined using the Hospital Frailty Risk Score.

What relationship does frailty have with the site of care?

Multivariable analysis shows frailty or prefrailty is associated with increased inpatient care.

Do transfer rates from ASCs to acute care hospitals remain low for prefrail and frail patients?

Yes. Although transfer odds are higher among prefrail and frail patients, observed transfer rates remain low (below 0.4%).

What are the cost implications of providing care in ASCs for prefrail and frail patients?

Expected costs are higher for prefrail and frail patients compared with robust patients, but if ASC transfer rates stay at current levels, average cost savings are estimated at $8,404 per patient.

Sep 28, 2026

Uploaded by Connor