Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
The Ohio State University College of Medicine, Columbus, OH, USA.
Ann Surg Oncol. 2024 Nov;31(12):8170-8178. doi: 10.1245/s10434-024-16042-w. Epub 2024 Aug 19.
Primary care (PC) is essential to overall wellness and management of comorbidities. In turn, patients without adequate access to PC may face healthcare disparities. We sought to characterize the impact of established PC on postoperative outcomes among patients undergoing a surgical procedure for a digestive tract cancer.
Medicare beneficiaries with a diagnosis of hepatobiliary, pancreas, and colorectal cancer between 2005 and 2019 were identified within the Surveillance, Epidemiology, and End Results program and Medicare-linked database. Individuals who did versus did not have PC encounters within 1-year before surgery were identified. A postoperative textbook outcome (TO) was defined as the absence of complications, no prolonged hospital stay, no readmission within 90 days, and no mortality.
Among 63,177 patients, 50,974 (80.7%) had at least one established PC visit before surgery. Patients with established PC were more likely to achieve TO (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.09-1.19) with lower odds for complications (OR, 0.85; 95% CI, 0.72-0.89), extended hospital stay (OR, 0.86; 95% CI, 0.81-0.94), 90-day readmission (OR, 0.94; 95% CI, 0.90-0.99), and 90-day mortality (OR, 0.87; 95% CI, 0.79-0.96). In addition, patients with established PC had a 4.1% decrease in index costs and a 5.2% decrease in 1-year costs. Notably, patients who had one to five visits with their PC in the year before surgery had improved odds of TO (OR, 1.21; 95% CI, 1.16-1.27), whereas individuals with more than 10 visits had lower odds of a postoperative TO (OR, 0.91; 95% CI, 0.84-0.98).
Most Medicare beneficiaries with digestive tract cancer had established PC within the year before their surgery. Established PC was associated with a higher probability of achieving ideal outcomes and lower costs. In contrast, patients with more than 10 PC appointments, which was likely a surrogate of overall comorbidity burden, experienced no improvement in postoperative outcomes.
初级保健（PC）对整体健康和共病管理至关重要。反过来，那些无法获得足够 PC 的患者可能会面临医疗保健方面的差异。我们试图描述在接受消化系统癌症手术的患者中，已建立的 PC 对术后结果的影响。
在监测、流行病学和最终结果计划以及医疗保险相关数据库中，确定了 2005 年至 2019 年间患有肝胆、胰腺和结直肠癌的 Medicare 受益人。确定了在手术前 1 年内是否有 PC 就诊的个体。术后教科书结局（TO）定义为无并发症、无延长住院时间、90 天内无再入院和无死亡。
在 63177 名患者中，50974 名（80.7%）在手术前至少有一次已建立的 PC 就诊。与没有已建立的 PC 的患者相比，有已建立的 PC 的患者更有可能达到 TO（优势比 [OR]，1.14；95%置信区间 [CI]，1.09-1.19），并发症的可能性较低（OR，0.85；95% CI，0.72-0.89），延长住院时间（OR，0.86；95% CI，0.81-0.94），90 天内再入院（OR，0.94；95% CI，0.90-0.99），90 天死亡率（OR，0.87；95% CI，0.79-0.96）。此外，有已建立的 PC 的患者的指数费用降低了 4.1%，1 年费用降低了 5.2%。值得注意的是，在手术前一年中有 1 到 5 次 PC 就诊的患者，TO 的可能性更高（OR，1.21；95% CI，1.16-1.27），而进行了 10 次以上 PC 就诊的患者术后 TO 的可能性更低（OR，0.91；95% CI，0.84-0.98）。
大多数患有消化系统癌症的 Medicare 受益人在手术前一年内都有已建立的 PC。已建立的 PC 与实现理想结果的可能性增加和成本降低有关。相比之下，进行了 10 多次 PC 预约的患者（这可能是整体合并症负担的替代指标），术后结果没有改善。
