For readmissions after colorectal surgery, care by same surgeon improves survival

Last Updated: 2017-07-11

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - For patients with complications after colorectal surgery, being readmitted to the same medical center and being cared for by the surgeon who performed the operation may increase the likelihood of survival, data from New York State suggest.

"Our study suggests that continuity of patient care at the hospital level is not sufficient and that continuity of care at the provider level appears to positively impact a patient's outcome," senior author Dr. Fergal Fleming from the University of Rochester told Reuters Health in an email.

"Patients who had hospital continuity paired with surgeon care fragmentation had similar characteristics and similar two-fold increased risk of death by one year as did patients with combined hospital and surgeon care fragmentation. The availability of information within a hospital does not appear to mitigate the impact of surgeon care fragmentation," explained coauthor Dr. Carla Justiniano.

“We were surprised to find that the impact of surgeon care fragmentation was greatest for patients who underwent elective surgery versus non-elective surgery. But in elective cases we have time for pre-operative instructions and continuity planning. So this is an area that can be addressed and improved upon,” she added in an email.

Dr. Justiniano and her colleagues reviewed data from the New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS) for outcomes of unscheduled readmissions within 30 days of discharge after colectomy or proctectomy between 2004 and 2014.

They presented their findings June 12 at the 2017 American Society of Colon and Rectal Surgeons Annual Scientific Meeting in Seattle, Washington.

Using a multi-level Cox model and competing risk Cox models adjusted for specifics of the patient, index-hospital and index-surgeon, the authors compared overall survival and colorectal-cancer-specific survival at one year.

Altogether, 166,198 patients were included; 96% were discharged alive and 12% had unscheduled readmissions.

Of the readmitted patients, 41% were readmitted to the index hospital by the index surgeon (+iH/+iS), 46% were readmitted to the index hospital by another provider(+iH/-iS), 1% were admitted to another hospital by the index surgeon(-iH/+iS), and 12% were admitted to another hospital by another provider(-iH/-iS).

After adjustments for potential confounders, patients readmitted to +iH/+iS tended to live longer. By contrast, overall survival was poorer for patients readmitted to +iH/-iS (hazard ratio 1.73, 95% confidence interval 1.63 to 1.84) and -iH/-iS (HR 1.61, 95% CI 1.47 to 1.74).

The pattern was similar for colorectal-cancer-specific one-year survival.

“The biggest question that remains unanswered is why," Dr. Justiniano said. "Why do patients do worse with surgeon care fragmentation, and what processes of care are impacted by fragmentation and lead to inferior outcomes? Such questions can be tackled through more qualitative studies evaluating processes of care delivery.”

"We are planning future studies to explore the factors that impact this observation," Dr. Fleming added.

A report of the study has been accepted for publication in Diseases of the Colon and Rectum.

SOURCE: http://bit.ly/2u1rZ9B

American Society of Colon and Rectal Surgeons 2017.