Munir Muhammad Musaab, Woldesenbet Selamawit, Pawlik Timothy M
From the Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
J Am Coll Surg. 2025 Jan 1;240(1):24-33. doi: 10.1097/XCS.0000000000001212. Epub 2024 Dec 16.
Frailty correlates with worse postoperative outcomes and higher surgical cost, but the long-term impact on healthcare use remains ill-defined. We sought to evaluate patterns of healthcare use pre- and postsurgery among patients with gastrointestinal cancer and characterize the association with frailty.
Data on patients who underwent surgical resection for liver, biliary, pancreatic, colon and rectal cancer were obtained from the SEER-Medicare database from 2005 to 2020. Frailty was assessed using the claims-based frailty index. Group-based trajectory modeling identified clusters of patients with discrete patterns of healthcare use. Multivariable regression was performed to predict cluster membership based on preoperative factors, including frailty.
Among 66,684 beneficiaries, 4 distinct use trajectories based on data from 12 months before and after surgical resection were identified. After a surge in use during the month of surgical resection, most patients reverted to presurgery baseline use (low: 6,588, 9.9%; moderate: 17,627, 26.4%; and high: 29,850, 44.8%). However, a notable trajectory involving 12,619 (18.9%) patients was identified, wherein surgical resection precipitated a transition from a "low" presurgery use state to a "high" use state postsurgery. Frail patients were more likely to be among those individuals who transitioned to high users (low: 4.2% vs transition: 12.6% vs high: 7.5%; p < 0.001). On multivariable analysis incorporating preoperative variables, frailty was associated with high group trajectory membership (ref: least and moderate; highest: odds ratio 4.90, 95% CI 4.49 to 5.35; p < 0.001).
Patients with gastrointestinal cancer demonstrated distinct clusters of healthcare use after surgical resection. Preoperative predictive models may help differentiate different healthcare use trajectories to help tailor care for patients in the postoperative period.
衰弱与术后不良结局及更高的手术成本相关，但对医疗保健使用的长期影响仍不明确。我们试图评估胃肠道癌患者手术前后的医疗保健使用模式，并描述其与衰弱的关联。
从2005年至2020年的监测、流行病学和最终结果-医疗保险数据库中获取接受肝脏、胆道、胰腺、结肠和直肠癌手术切除患者的数据。使用基于索赔的衰弱指数评估衰弱情况。基于群体的轨迹模型确定了具有不同医疗保健使用模式的患者集群。进行多变量回归以根据术前因素（包括衰弱）预测集群成员身份。
在66684名受益人中，根据手术切除前后12个月的数据确定了4种不同的使用轨迹。在手术切除当月使用量激增后，大多数患者恢复到术前基线使用水平（低：6588例，9.9%；中：17627例，26.4%；高：29850例，44.8%）。然而，确定了一条涉及12619名（18.9%）患者值得注意的轨迹，其中手术切除促使患者从术前“低”使用状态转变为术后“高”使用状态。衰弱患者更有可能属于那些转变为高使用者的人群（低：4.2% 对比转变：12.6% 对比高：7.5%；p < 0.001）。在纳入术前变量的多变量分析中，衰弱与高群体轨迹成员身份相关（对照：最低和中等；最高：比值比4.90，95%置信区间4.49至5.35；p < 0.001）。
胃肠道癌患者在手术切除后表现出不同的医疗保健使用集群。术前预测模型可能有助于区分不同的医疗保健使用轨迹，以帮助为术后患者量身定制护理。
