Patterns and Consequences of Care Fragmentation in Post-Surgical Management of Upper Gastrointestinal and Hepatopancreatobiliary Cancers

作者：Melissa Justo, Konmal Ali, Sara Sakowitz, Ayesha P. Ng, Sona Mahrokhi, Syed Shaheer Ali, Peyman Benharash, Mark D. Girgis · 发表于：Annals of Surgical Oncology · 年份：2025 · DOI：10.1245/s10434-025-18052-8 · 被引用次数：2 · 研究领域：Pancreatic and Hepatic Oncology Research、Gallbladder and Bile Duct Disorders、Enhanced Recovery After Surgery

BACKGROUND: Upper gastrointestinal (UGI) and hepatopancreatobiliary (HPB) oncologic operations are frequently performed at major referral centers. Postoperatively, many patients face care fragmentation (CF), which has been previously linked to inferior outcomes. This analysis examines clinical and financial outcomes of CF following UGI and HPB cancer operations. PATIENTS AND METHODS: The 2016-2022 Nationwide Readmissions Database identified adults (≥ 18 years) who underwent UGI and HPB oncologic surgery. Patients readmitted to a nonindex facility within 30 days of discharge comprised the CF cohort. Multivariable models assessed the association of CF with clinical outcomes and identified related factors. RESULTS: Among 8384 UGI and 16,235 HPB surgical oncology patients, CF affected 15.2% and 13.3%, respectively. CF was associated with higher rates of major adverse events in both groups. Patients undergoing the UGI procedure showed increased odds of respiratory complications (adjusted odds ratio [AOR] 1.67, 95% confidence interval [CI] 1.34, 2.09), while patients undergoing the HPB procedure experienced higher risks of in-hospital mortality (AOR 1.84, 95% CI 1.15-2.94), cardiac (AOR 1.74 95% CI 1.12, 2.71), and respiratory (AOR 2.45, 95% CI 1.87, 3.21) complications. CF was not associated with increased hospitalization costs or longer stays in either cohort. CONCLUSIONS: CF significantly affects postoperative outcomes following UGI and HPB cancer surgeries, with differential im...