ImportanceMultimorbidity and postoperative clinical decompensation are common among older surgical patients with cancer, highlighting the importance of primary care to optimize survival. Little is known about the association between primary care use and survivorship among older adults (aged ≥65 years) undergoing cancer surgery.ObjectiveTo examine primary care use among older surgical patients with cancer and its association with mortality.Design, Setting, and ParticipantsIn this retrospective cohort study, data were abstracted from the electronic health record of a single health care system for older adults undergoing cancer surgery between January 1, 2017, and December 31, 2019. There were 3 tiers of stratification: (1) patients who had a primary care practitioner (PCP) (physician, nurse practitioner, or physician assistant) vs no PCP, (2) those who had a PCP and underwent surgery in the same health system (unfragmented care) vs not (fragmented care), and (3) those who had a primary care visit within 90 postoperative days vs not. Data were analyzed between August 2023 and January 2024.ExposurePrimary care use after surgery for colorectal, head and neck, prostate, ovarian, pancreatic, breast, liver, renal cell, non–small cell lung, endometrial, gastric, or esophageal cancer.Main Outcomes and MeasuresPostoperative 90-day mortality was analyzed using inverse propensity weighted Kaplan-Meier curves, with log-rank tests adjusted for propensity scores.ResultsThe study included 2566 older adults (mean [SEM] age, 72.9 [0.1] years; 1321 men [51.5%]). Although 2404 patients (93.7%) had health insurance coverage, 743 (28.9%) had no PCP at the time of surgery. Compared with the PCP group, the no-PCP group had a higher 90-day postoperative mortality rate (2.0% vs 3.6%, respectively; adjusted P = .03). For the 823 patients with unfragmented care, 400 (48.6%) had a primary care visit within 90 postoperative days (median time to visit, 34 days; IQR, 20-57 days). Patients who had a postoperative primary care visit were more likely to be older, have a higher comorbidity burden, have an emergency department visit, and be readmitted. However, they had a significantly lower 90-day postoperative mortality rate than those who did not have a primary care visit (0.3% vs 3.3%, respectively; adjusted P = .001).Conclusions and RelevanceThese findings suggest that follow-up with primary care within 90 days after cancer surgery is associated with improved survivorship among older adults.

中文翻译：

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接受癌症手术的老年人的初级保健使用情况和 90 天死亡率


重要性多病共存和术后临床失代偿在老年外科癌症患者中很常见，这凸显了初级保健对优化生存率的重要性。对于接受癌症手术的老年人 （≥65 岁） 初级保健使用与生存率之间的关联，目前知之甚少。目的探讨老年外科癌症患者的初级保健使用情况及其与死亡率的关系。设计、设置和参与者在这项回顾性队列研究中，数据是从 2017 年 1 月 1 日至 2019 年 12 月 31 日期间接受癌症手术的老年人的单一医疗保健系统的电子健康记录中提取的。有 3 个分层层次：（1） 有初级保健医生 （PCP）（医生、执业护士或医生助理）的患者与无 PCP，（2） 有 PCP 并在同一卫生系统中接受手术的患者（完整护理）与未接受手术（碎片化护理），以及 （3） 术后 90 天内进行过初级保健就诊的患者与未就诊的患者。数据在 2023 年 8 月至 2024 年 1 月期间进行了分析。主要结局和指标使用逆倾向加权 Kaplan-Meier 曲线分析术后 90 天死亡率，并针对倾向评分调整对数秩检验。结果该研究包括 2566 名老年人 （平均 [SEM] 年龄，72.9 [0.1] 岁;1321 名男性 [51.5%]）。尽管 2404 名患者 （93.7%） 有健康保险，但 743 名患者 （28.9%） 在手术时没有 PCP。与 PCP 组相比，无 PCP 组术后 90 天死亡率更高 （2.0% vs 3.分别为 6%;调整后 P = .03）。对于 823 名未碎片化护理的患者，400 名 （48.6%） 在术后 90 天内进行了初级保健就诊（中位就诊时间为 34 天;IQR，20-57 天）。术后进行初级保健就诊的患者更有可能年龄较大，合并症负担更高，需要急诊科就诊，并再次入院。然而，他们的术后 90 天死亡率显著低于未进行初级保健就诊的患者（分别为 0.3% 和 3.3%;调整后的 P = .001）。结论和相关性这些发现表明，癌症手术后 90 天内的初级保健随访与老年人生存率的提高有关。