Hospital Factors Associated with Fragmentation of Care in Emergency General Surgery: Less Continuity, Higher...

Area of Science:

• Surgical Care
• Health Services Research
• Patient Outcomes

Background:

• Fragmentation of care (FOC), defined as readmission to a non-index hospital, is a concern in emergency general surgery (EGS).
• FOC may be associated with adverse outcomes in EGS patients.
• Understanding hospital characteristics linked to FOC patterns is crucial.

Purpose of the Study:

• To assess hospital characteristics associated with FOC patterns in EGS patients.
• To evaluate the impact of interfacility transfer after FOC on mortality.
• To identify factors contributing to fragmented care in EGS.

Main Methods:

• Analysis of the 2019 Nationwide Readmissions Database for EGS patients aged 18+.
• Classification of patients into four FOC patterns: no FOC, FOC, defragmented, and hyperfragmented care.
• Multivariable logistic regression to identify hospital characteristics associated with FOC and its effect on 90-day mortality, controlling for patient severity (APR-DRG).

Main Results:

• 16.4% of 26,100 EGS patients experienced FOC.
• FOC was associated with smaller hospital size, private/government ownership, and lower EGS volumes.
• FOC significantly increased 90-day mortality (OR 1.22), particularly for patients with high severity of illness (OR 1.36).

Conclusions:

• Fragmentation of care is significantly associated with worse outcomes in EGS patients.
• Hospital characteristics play a role in the patterns of FOC observed.
• Further research into EGS systems of care is needed to mitigate the negative impacts of FOC.