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

Abstract

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. 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. 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. CF significantly affects postoperative outcomes following UGI and HPB cancer surgeries, with differential impacts between cohorts. The lack of association with increased costs or longer hospital stays may reflect suboptimal care continuity rather than equivalent efficiency. Given CF's persistent prevalence and clinical significance, these findings highlight the need for enhanced interhospital coordination to improve outcomes for complex oncologic surgical patients.