Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2026
Association of care fragmentation and mortality after curative-intent gastrointestinal cancer surgery.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Charalampous Charalampos M, Bega Rabia, Woldesenbet Selamawit, Angez Meher, Arena Lorenza, Yuza Kizuki, Pawlik Timothy M
Аннотация
BACKGROUND: Regionalization of complex gastrointestinal (GI) cancer surgery to high-volume centers can increase the risk of unplanned readmission to a different hospital, known as care fragmentation. We sought to assess the association between care fragmentation and 90-day mortality.
METHODS: Patients who underwent curative-intent surgery for hepatopancreatobiliary or colorectal cancer were identified using the Surveillance, Epidemiology, and End Results-Medicare database (2007-2020). Care fragmentation was defined as an unplanned 30-day readmission to a hospital other than the index hospital. Mixed-effects models with sequential adjustment for patient-level, hospital-level, and geographic distance characteristics were used to estimate the association between care fragmentation and 90-day mortality.
RESULTS: Among 63,908 patients, 13.8% (n = 8805) were readmitted within 30 days; 19.0% (n = 1671) of these individuals experienced fragmented care. Patients with fragmented care more often resided in high Social Vulnerability Index areas (36.9%, n = 617 vs 32.6%, n = 2324) and more frequently underwent surgery at teaching hospitals (63.6%, n = 1062 vs 57.7%, n = 4116) compared with patients readmitted to the index hospital (both P <.001). Interestingly, the distance between residence and index facility was considerably longer among individuals who experienced fragmented care (median, 26.97 km [IQR, 9.98-76.26] vs median, 11.56 km [IQR, 5.05-27.82]; P <.001). After adjustment for patient- and hospital-level factors, as well as distance to the hospital, fragmented care was independently associated with higher odds of 90-day mortality (adjusted odds ratio, 1.40; 95% CI, 1.21-1.61).
CONCLUSION: Care fragmentation was associated with substantially higher mortality among older adults who were readmitted after GI cancer surgery. Investment in cross-institutional continuity of care is needed to preserve the survival benefits of centralized surgery upon discharge.
METHODS: Patients who underwent curative-intent surgery for hepatopancreatobiliary or colorectal cancer were identified using the Surveillance, Epidemiology, and End Results-Medicare database (2007-2020). Care fragmentation was defined as an unplanned 30-day readmission to a hospital other than the index hospital. Mixed-effects models with sequential adjustment for patient-level, hospital-level, and geographic distance characteristics were used to estimate the association between care fragmentation and 90-day mortality.
RESULTS: Among 63,908 patients, 13.8% (n = 8805) were readmitted within 30 days; 19.0% (n = 1671) of these individuals experienced fragmented care. Patients with fragmented care more often resided in high Social Vulnerability Index areas (36.9%, n = 617 vs 32.6%, n = 2324) and more frequently underwent surgery at teaching hospitals (63.6%, n = 1062 vs 57.7%, n = 4116) compared with patients readmitted to the index hospital (both P <.001). Interestingly, the distance between residence and index facility was considerably longer among individuals who experienced fragmented care (median, 26.97 km [IQR, 9.98-76.26] vs median, 11.56 km [IQR, 5.05-27.82]; P <.001). After adjustment for patient- and hospital-level factors, as well as distance to the hospital, fragmented care was independently associated with higher odds of 90-day mortality (adjusted odds ratio, 1.40; 95% CI, 1.21-1.61).
CONCLUSION: Care fragmentation was associated with substantially higher mortality among older adults who were readmitted after GI cancer surgery. Investment in cross-institutional continuity of care is needed to preserve the survival benefits of centralized surgery upon discharge.