Association of Care Fragmentation and Mortality Following Curative-Intent Gastrointestinal Cancer Surgery

Area of Science:

• Oncology
• Health Services Research
• Surgical Outcomes

Background:

• Regionalization of complex gastrointestinal (GI) cancer surgery to high-volume centers aims to improve outcomes.
• However, this can lead to care fragmentation, defined as unplanned readmission to a non-index hospital.
• Care fragmentation may negatively impact patient survival after surgery.

Purpose of the Study:

• To assess the association between care fragmentation and 90-day mortality in patients undergoing GI cancer surgery.
• To identify factors associated with care fragmentation in this patient population.

Main Methods:

• Retrospective analysis of SEER-Medicare data (2007-2020) for patients with hepatopancreatobiliary or colorectal cancer.
• Care fragmentation defined as unplanned 30-day readmission to a different hospital.
• Mixed-effects models used to adjust for patient, hospital, and geographic factors.

Main Results:

• 13.8% of patients experienced 30-day readmission; 19.0% of these had fragmented care.
• Fragmented care patients had longer distances from residence to index facility and more often resided in high Social Vulnerability Index (SVI) areas.
• Fragmented care was independently associated with a 40% increased odds of 90-day mortality (aOR 1.40; 95% CI 1.21-1.61).

Conclusions:

• Care fragmentation is linked to significantly higher 90-day mortality in older adults after GI cancer surgery.
• There is a need for enhanced cross-institutional continuity of care to maintain survival benefits of centralized surgery.
• Interventions addressing care transitions are essential to mitigate risks associated with fragmented care.