Patterns of use of common major procedures in medical care of older adults.
OBJECTIVE
We analyzed Medicare data to determine the influence of age, mortality during the study year, and high individual Medicare costs on the frequency of hospitalization for the most common major procedures and for general medical diagnoses.


METHODS
We used 1992 Medicare data to classify the most frequent diagnosis related groups (DRGs), representing one-half of all admissions, as procedural or general medical. We studied the frequency of hospitalization for the most common procedures (bowel surgery, cardiovascular procedures, hip and femur surgery) and for general medical care in the entire Medicare population, in persons aged 65 to 74, 75 to 84, and 85 or older, in those who died, and in the 5% of persons whose annual Medicare costs were the highest.


RESULTS
In the entire population, common procedures accounted for 21% of the most frequent DRGs. Among those who died, the procedures were performed in only 8% of admissions. In the 5% of persons with the highest Medicare costs, 28% of admissions involved procedures. Admissions for cardiovascular procedures and for cancer chemotherapy decreased with age and were infrequent in persons 85 years and older. Hip and femur procedures increased with age and accounted for 70% of the common procedures in persons 85 years and older.


CONCLUSIONS
The most common major procedures account for a minority of hospitalizations of persons more than age 65, of persons 85 and older, of those who died, and of persons with the highest Medicare expenditures. Most hospitalizations are for general medical care. Major procedures appear to be used with restraint in the very old and in persons in their last year of life.
D000368:Aged; D000369:Aged, 80 and over; D003953:Diagnosis-Related Groups / Q000145:classification / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D009026:Mortality; D010343:Patient Admission / Q000706:statistics & numerical data; D013514:Surgical Procedures, Operative / Q000191:economics / Q000706:statistics & numerical data; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data*