Postacute care services after major abdominal cancer surgery in rural populations: guidance into future intervention

Postacute care services (PACS) are a costly and growing disposition, yet little is known about PACS patterns after major cancer surgery, particularly among rural populations given their complex payor mix and medical and social determinants of health. This study aimed to robustly examine the within-rural-population factors associated with PACS after major abdominal surgery.

Hospitalizations of rural patients who underwent major abdominal cancer surgery were identified in the 2016 to 2021 National Inpatient Sample. Patient- and hospital-level factors were compared by patterns of PACS utilization. Adjusting for these factors, multivariable logistic regression analyses were performed to identify predictors of PACS.

Nearly half of the 35,570 hospitalizations among rural patients received PACS. Medicare and Medicaid accounted for nearly 70% of the payors' mix. Longer length of stay (LOS) was associated with increased likelihood of PACS (P <.0001), as was every 1-day increase in LOS (home healthcare, adjusted odds ratio [aOR], 1.09; P <.0001; transfers, aOR, 1.15; P <.0001). Significant drivers of PACS were older age (vs <65 years, aOR, 1.47; P <.0001), Medicare insurance (vs private, aOR, 1.77; P <.0001), and Medicaid insurance (vs private, aOR, 1.23; P =.0445). In contrast, non-White race (vs White, aOR, 0.81; P =.0132) and no insurance (vs private, aOR, 0.63; P =.0011) were associated with fewer PACS.

Nearly half of rural patients received PACS after major abdominal cancer surgery. PACS were largely driven by older age, Medicare or Medicaid insurance, and prolonged LOS. Further work to investigate additional sociodemographic factors influencing PACS would be beneficial for government, payor, and hospital system planning and would assist in providing high-quality care to rural patients.