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Mortality Risk Up for Fragmented Care After Complex Cancer Surgery

MONDAY, May 3, 2021 -- Travel distance and timing contribute to care fragmentation following hepatopancreatobiliary (HPB) and gastric oncologic operations, according to a study published online April 15 in the Journal of the American College of Surgeons.

David G. Brauer, M.D., from the Washington University School of Medicine in St. Louis, and colleagues used the Healthcare Cost and Utilization Project database (2006 to 2014) to identify patients undergoing HPB or gastric oncologic surgery with 90-day follow-up data to assess readmission to outside hospitals (OSH).

The researchers identified 7,536 patients readmitted within 90 days of HPB or gastric oncologic surgery to 636 hospitals, including 28 percent to an OSH. At OSH 90-day readmission, mortality was significantly higher (8.0 versus 5.4 percent). Although not associated with readmission mortality, patients readmitted to an OSH lived farther from the index surgical hospital (median 24 miles versus 10 miles) and were readmitted later (median 25 days after discharge versus 12). There was an association noted between surgical complications managed at an OSH and greater readmission mortality (8.4 versus 5.7 percent).

"This centralization of cancer surgical care means many patients travel great distances to undergo their operations and therefore may need to present instead to a hospital closer to home if they experience complications. That hospital may not have access to the patient's surgical records or even the specialists to care for patients with such complex medical problems," Brauer said in a statement. "Patients who experience this type of care fragmentation die more often than patients who don't experience care fragmentation. Convenience of care should not come at the expense of getting the appropriate care."

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