Potential ways to improve survival for cancer patients who receive fragmented care


New research reveals that 28 percent of patients who are readmitted to the hospital with complications after surgical removal of pancreatic, liver, or stomach cancer go to a different hospital for follow-up care. This fragmentation of health care is associated with a 50 percent increased odds of dying, according to a study published online by the Journal of the American College of Surgeons ahead of print.

The researchers from Washington University School of Medicine, St. Louis, sought to identify patient and hospital characteristics that raise the death risk during readmission to an outside hospital—one other than the original hospital where the operation was performed, referred to as the index hospital. Using the state inpatient databases from the federal Healthcare Cost and Utilization Project, the investigators evaluated data from adults undergoing surgical removal of liver, pancreatic, bile duct, and gastric cancers beginning in 2006. Patients lived in California, Florida, or New York.

A total of 31,256 patients were discharged from the hospital postoperatively, and 7,536, or 24 percent, were readmitted to any hospital in the first three months after discharge. Among readmitted patients, 28 percent, or 2,123, went to an outside hospital. As in prior research, the study findings showed a higher death rate for those patients versus patients returning to the index hospital: 8 percent versus 5.4 percent.

Centralized cancer care not always aligned with readmissions

Most operations to remove liver, pancreatic, bile duct or stomach cancers take place at regional medical centers where surgical teams perform a large volume of these complex procedures. These operations have high rates of complications and readmissions, and large surgical volume is associated with improved outcomes.

“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,” said the study’s lead investigator, David G. Brauer, MD, MPHS. “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.”