ArticleJournal of the American College of Surgeons2021
Care Fragmentation and Mortality in Readmission after Surgery for Hepatopancreatobiliary and Gastric Cancer: A Patient-Level and Hospital-Level Analysis of the Healthcare Cost and Utilization Project Administrative Database.
Article in Journal of the American College of Surgeons, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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12 citing papers in PubMed, 23 citations in OpenAlex.
- Low protein, high risk: hypoalbuminemia predicts adverse outcomes after mastectomy in 37,848 breast cancer patients.Breast cancer (Tokyo, Japan) · 2026Article
- Divided care, diminished outcomes? The impact of care fragmentation on survival in glioblastoma.Journal of neuro-oncology · 2026Article
- Association Among Fragmented Trauma Care, Mortality, and Major Complications: Optimizing Care for the Injured Beyond the Initial Hospitalization.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2025Article
- Impact of fragmented care on cancer outcomes among korean women with breast and cervical cancer: a focus on regional and economic disparities.International journal for equity in health · 2025Article
- Association of polydoctoring and mortality among persons over 85 years with multimorbidity: a prospective cohort study in Japan.BJGP open · 2024Article
- Establishing Regionalized Acute Care Across a Health Care System to Decentralize Postoperative Care After Oncologic Surgery.JCO oncology practice · 2024Article
- Predictors and Significance of Readmission after Esophagogastric Surgery: A Nationwide Analysis.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2024Article
- Fragmentation of Care in Patients with Peritoneal Metastases Undergoing Cytoreductive Surgery.Annals of surgical oncology · 2024Article
- Greater Patient Travel Distance is Associated with Perioperative and One-Year Cost Increases After Complex Aortic Surgery.Annals of vascular surgery · 2023Article
- Influence of the centralizing gastric cancer surgery on the health-related quality of life in Brazil.Journal of gastrointestinal oncology · 2023Article
- Multi-institutional Care in Clinical Stage II and III Esophageal Cancer.The Annals of thoracic surgery · 2023Article
- Patterns and Impact of Fragmented Care in Stage II and III Gastric Cancer.Annals of surgical oncology · 2022Article
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9 authors at 1 institution in 1 country.
Funding
Abstract
backgroundHepatopancreatobiliary (HPB) and gastric oncologic operations are frequently performed at referral centers. Postoperatively, many patients experience care fragmentation, including readmission to "outside hospitals" (OSH), which is associated with increased mortality. Little is known about patient-level and hospital-level variables associated with this mortality difference. STUDY
designPatients undergoing HPB or gastric oncologic surgery were identified from select states within the Healthcare Cost and Utilization Project database (2006-2014). Follow-up was 90 days after discharge. Analyses used Kruskal-Wallis test, Youden index, and multilevel modeling at the hospital level.
resultsThere were 7,536 patients readmitted within 90 days of HPB or gastric oncologic surgery to 636 hospitals; 28% of readmissions (n = 2,123) were to an OSH, where 90-day readmission mortality was significantly higher: 8.0% vs 5.4% (p < 0.01). Patients readmitted to an OSH lived farther from the index surgical hospital (median 24 miles vs 10 miles; p < 0.01) and were readmitted later (median 25 days after discharge vs 12; p < 0.01). These variables were not associated with readmission mortality. Surgical complications managed at an OSH were associated with greater readmission mortality: 8.4% vs 5.7% (p < 0.01). Hospitals with <100 annual HPB and gastric operations for benign or malignant indications had higher readmission mortality (6.4% vs 4.7%, p = 0.01), although this was not significant after risk-adjustment (p = 0.226).
conclusionsFor readmissions after HPB and gastric oncologic surgery, travel distance and timing are major determinants of care fragmentation. However, these variables are not associated with mortality, nor is annual hospital surgical volume after risk-adjustment. This information could be used to determine safe sites of care for readmissions after HPB and gastric surgery. Further analysis is needed to explore the relationship between complications, the site of care, and readmission mortality.
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