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 18 January 2018

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News

Long-term deleterious impact of surgeon care fragmentation after colorectal surgery on survival

The most recent issue of the Diseases of the Colon & Rectum examines the long-term deleterious impact of surgeon care fragmentation after colorectal surgery on survival.

News image

Surgical care fragmentation at readmission impacts short-term outcomes. However, the long-term impact of surgical care fragmentation is unknown.

Dr Carla Justiniano and colleagues evaluated the impact of surgical care fragmentation, encompassing both surgeon and hospital care, at readmission after colorectal surgery on 1-year survival.

The team performed a retrospective cohort study.

The research team included patients undergoing colorectal resection in New York State from 2004 to 2014.

Included were 20,016 patients undergoing colorectal resection who were readmitted within 30 days of discharge and categorized by source-of-care fragmentation.

Each readmission was classified by the source of fragmentation: readmission to the index hospital and managed by another provider, readmission to another hospital by the index surgeon, and readmission to another hospital by another provider.

The researchers reported that patients readmitted to the index hospital and managed by the index surgeon served as controls.

Surgical care fragmentation was associated with decreased survival
Diseases of the Colon & Rectum

The team's main outcomes included 1-year overall survival and 1-year colorectal cancer-specific survival.

After propensity adjustment, the researchers observed that surgeon care fragmentation was independently associated with decreased survival.

In comparison with patients without surgical care fragmentation, patients readmitted to the index hospital and managed by another provider had over a 2-fold risk, and patients readmitted to another hospital by another provider had almost a 2-fold risk of 1-year mortality.

Among 9545 patients with a colorectal cancer diagnosis, the team noted that surgical care fragmentation was once again associated with decreased survival with patients readmitted to the index hospital and managed by another provider having a hazard ratio of 2.12, and patients readmitted to another hospital by another provider having a hazard ratio of 1.57 compared with patients readmitted to the index hospital and managed by the index surgeon.

Dr Justiniano's team concludes, "After accounting for patient, index hospital, index surgeon, and readmission factors, there is a significant 2-fold decrease in survival associated with surgeon care fragmentation regardless of hospital continuity."

Dis Colon Rectum 2017: 60(11): 1147–1154
16 October 2017

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