Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.
On August 8, 2024, we reported on findings from a study published in JAMA Surgery that examined the association between primary care use and 90-day postoperative mortality among older adults undergoing cancer surgery.
The study
Researchers assessed data from 2566 participants aged 65 years and older who underwent inpatient surgery for 1 of 12 cancer types at the Duke University Health System (DUHS) between January 1, 2017, and December 31, 2019. Participants were categorized into the following 3 tiers:
Patients with a PCP vs no PCP
Those who had a PCP and underwent surgery at DUHS (unfragmented care) vs not (fragmented care)
Those who had a primary care visit within 90 postoperative days vs not
The main outcome was postoperative 90-day mortality risk. The mean age of the cohort was 72.9 years, and 51.5% were men and 74.3% were White. Nearly all participants (93.7%) had medical insurance, but more than one-quarter (28.9%) had no PCP.
The findings
Compared with participants in the PCP group, those in the no-PCP group had a higher 90-day postoperative mortality rate (3.6% vs 2.0%; adjusted P = .03).
In a subanalysis of participants who had unfragmented care (ie, underwent surgery and had a PCP visit within the same study institution), those who had a postoperative primary care visit had a significantly lower 90-day postoperative mortality rate compared to those who did not (0.3% vs 3.3%; adjusted P = .001).
There were no differences in sex, race and ethnicity, health insurance coverage, or urgency of surgery between participants who had a primary care visit and those who did not. However, researchers reported individuals with a postoperative PCP visit were older, had higher comorbidity burden, visited the emergency department (ED) more frequently, and were readmitted more often than those who did not.
Authors' comment
"In line with emerging literature suggesting that a team-based approach between PCPs and oncology teams may substantially improve survivorship, our results are foundational for further studies on surgery and primary care engagement, which may aid the development of postoperative oncology–primary care models to optimize survivorship of older adults after cancer surgery."
