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Nationwide analysis of fragmentation of care after complex cancer surgery
Faisal S Jehan1, Kamil Hanna2, Zainab Mehdi1
1Division of Surgical Oncology, Department of Surgery, University of Arizona, Tucson, AZ, United States.
Background:
Patients who undergo complex cancer surgery (CCS) require comprehensive care after discharge. This study evaluates the magnitude of fragmentation of care (FOC), determines its effect on outcomes, and identifies associated factors.
Methods:
We analyzed the pooled 2020 to 2022 Nationwide Readmission Database. Adult patients (≥18 years) who underwent CCS were included. Patients were stratified into index readmission and nonindex readmission (NIR). Primary outcomes were the overall rate of NIR, 6-month mortality, 6-month failure-to-rescue (FTR), readmission length of stay, and healthcare charges; secondary outcomes were factors associated with NIR.
Results:
A total of 33,802 patients were identified. Most patients (82.1%) underwent CCS at high-volume centers. The overall 6-month readmission rate was 41.4%. Of those readmitted (n = 13,987), 19.7% experienced NIR. Patients with NIR had higher mortality on readmission (7.9% vs 4.6%; P <.01) and FTR (7.7% vs 4.5%; P <.01). On multivariable analysis, factors associated with NIR were discharge to a facility (adjusted odds ratio [aOR], 1.32 [1.16-1.50]), nonelective index admission (aOR, 1.20 [1.08-1.32]), and higher Charlson Comorbidity Index (aOR, 1.04 [1.03-1.06]). Surgery at a high-volume center was associated with lower odds of NIR (aOR, 0.77 [0.69-0.86]).
Conclusion:
Approximately 1 in 5 readmitted CCS patients experience FOC, which is associated with discharge to postacute facilities, greater comorbidity, and nonelective surgery, and carries a higher risk of FTR, supporting continued regionalization coupled with stronger postdischarge care coordination.
