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Primary care utilization within a year of emergency general surgery was significantly associated with lower mortality up to 180 days later for older adults, based on data from more than 100,000 individuals.
Although previous research has shown the benefits of routine health and preventive care visits for surgery patients, many individuals in the United States live in areas with a shortage of primary care providers, wrote Sanford E. Roberts, MD, of the University of Pennsylvania, Philadelphia, and colleagues. The effect of primary care use on adverse outcomes after emergency general surgery, including mortality, remains unknown, they said.
In a study published in JAMA Surgery the researchers reviewed data from 102,384 Medicare patients aged 66 years and older who underwent emergency general surgery (EGS) between July 1, 2015, and June 30, 2018. Participants were classified into five EGS categories: colorectal, general abdominal, hepatopancreatobiliary, intestinal obstruction, and upper gastrointestinal. The mean age of the participants was 73.8 years; 8.4% were Black, 91.6% were White.
The primary outcome was mortality in hospital and at 30, 60, 90, and 180 days. In the year before hospitalization for EGS, 88,340 patients (86.3%) had visited a primary care physician.
After adjusting for multiple risk factors, the overall risk of in-hospital mortality was 19% lower for patients who had a history of primary care visits than for those without prior-year exposure to primary care (odds ratio, 0.81).
Mortality at 30 days was 27% lower overall in patients with primary care exposure, compared with those without primary care exposure (OR, 0.73). This trend continued at 60 days (OR, 0.75), 90 days (OR, 0.74), and 180 days (OR, 0.75); mortality rates at each time period were similar for Black and White patients with primary care exposure, both groups had reduced mortality, compared with those without primary care exposure.
However, when analyzed by race, in-hospital mortality was not significantly different for Black patients with and without primary care exposure (OR, 1.09), but in-hospital mortality was 21% less in White patients with primary care exposure (OR, 0.79). Interactions between race and primary care exposure related to mortality were not significantly different at any of the follow-up time points of 30, 60, 90, and 180 days.
“These findings suggest that primary care may be exerting a protective effect on postoperative morbidity and mortality,” the researchers wrote in their discussion. “This protective effect could be mediated through several different paths, such as identifying and managing a patient’s comorbidities, medically optimizing patients preoperatively, earlier detection of the primary EGS condition leading to early referral to treatment, and encouraging better lifestyle decisions,” they said.
The findings were limited by several factors including the retrospective design and inability to extract clinical data from a claims database, the researchers noted. Other limitations included potential confounding of unmeasured factors such as the other beneficial health behaviors often associated with seeking primary care.
Patients who avoid primary care may be more likely to delay presentation to the emergency department, which might promote poorer postoperative outcomes, the researchers said. Consequently, surgeons should consider primary care exposure in preoperative assessment, and perform a more comprehensive presurgical assessment as needed, the researchers said.
More studies are needed to examine trends in racial groups, but the results of the current study suggest that primary care provides similar benefits for Black and White individuals, and therefore could help reduce health disparities, they concluded.
Primary care benefits elude many patients
The current study shows a “rather dramatic” association between utilization of primary care within a year before surgery and patient mortality after surgery, wrote Caroline E. Reinke, MD, and David C. Slawson, MD, both of Atrium Health, Charlotte, N.C., in an accompanying editorial. The authors reiterated that possible reasons for the positive effect of primary care on postsurgical mortality included identification and management of comorbidities that could complicate surgery, as well as earlier detection of disease.
However, the editorialists noted that the benefits of primary care exposure depend on patient access to primary care, and on patient adherence to recommendations from their primary care provider. They identified barriers to potential effective interventions with primary care providers including time, money, and transportation.
An unanswered question is “whether the PCP visit itself is the causative factor associated with decreased mortality or if seeing a PCP on an annual basis is a marker of the patient possessing some other ‘magic sauce’ that improves outcomes,” they wrote.
Further, individuals in areas of primary care shortage also are more likely to lack the socioeconomic resources to benefit from primary care, the editorialists said. “Future evaluations of the interaction between PCP visits and social determinants of health may shed light on how to achieve the greatest impact,” they concluded.
Study supports value of consistent primary care
The increasingly aging population across the United States may undergo surgical procedures on an emergent basis and the current study provides data on the benefits of established and effective primary care for these individuals, said Noel Deep, MD, in an interview.
“Having data from this study supports the current position of many physicians and health care organizations and medical professional organizations that older individuals in particular, and adults in general, who have regular routine primary care visits tend to lead healthier lives and have better prognosis and quality of life,” said Dr. Deep, a general internist in private practice in Antigo, Wisc., who was not involved in the study. Dr. Deep also serves as chief medical officer and a staff physician at Aspirus Langlade Hospital in Antigo.
The study findings reinforce what most physicians in primary care, himself included, have been advising adult patients, especially older adults about maintaining regular follow-up visits with their physicians for health screening and management of chronic medical conditions, Dr. Deep said in an interview.
However, barriers to the routine use of primary care to improve postsurgical outcomes include health illiteracy, being overwhelmed by a sudden change in health or emergent surgery, and lack of access to primary care physician, as well as issues such as transportation, financial difficulties, and physical limitations, Dr. Deep added.
“Patients who avoid routine health care visits with primary care may be lacking health insurance or financial resources, have time constraints or family responsibilities, or may be unaware of the benefits of routine health care,” he noted.
As for additional research, “I would like to see studies that can document the impact of having primary care physicians comanage these hospitalized patients in the perioperative period with continued follow-up in the postoperative/convalescent period,” said Dr. Deep.
The study was supported by the National Institute on Aging of the National Institutes of Health. Dr. Roberts disclosed grants from the National Institute on Aging and from NIH during the conduct of the study. The editorial author had no financial conflicts to disclose. Dr. Deep had no financial conflicts to disclose and serves on the Editorial Advisory Board of Internal Medicine News.
Primary care utilization within a year of emergency general surgery was significantly associated with lower mortality up to 180 days later for older adults, based on data from more than 100,000 individuals.
Although previous research has shown the benefits of routine health and preventive care visits for surgery patients, many individuals in the United States live in areas with a shortage of primary care providers, wrote Sanford E. Roberts, MD, of the University of Pennsylvania, Philadelphia, and colleagues. The effect of primary care use on adverse outcomes after emergency general surgery, including mortality, remains unknown, they said.
In a study published in JAMA Surgery the researchers reviewed data from 102,384 Medicare patients aged 66 years and older who underwent emergency general surgery (EGS) between July 1, 2015, and June 30, 2018. Participants were classified into five EGS categories: colorectal, general abdominal, hepatopancreatobiliary, intestinal obstruction, and upper gastrointestinal. The mean age of the participants was 73.8 years; 8.4% were Black, 91.6% were White.
The primary outcome was mortality in hospital and at 30, 60, 90, and 180 days. In the year before hospitalization for EGS, 88,340 patients (86.3%) had visited a primary care physician.
After adjusting for multiple risk factors, the overall risk of in-hospital mortality was 19% lower for patients who had a history of primary care visits than for those without prior-year exposure to primary care (odds ratio, 0.81).
Mortality at 30 days was 27% lower overall in patients with primary care exposure, compared with those without primary care exposure (OR, 0.73). This trend continued at 60 days (OR, 0.75), 90 days (OR, 0.74), and 180 days (OR, 0.75); mortality rates at each time period were similar for Black and White patients with primary care exposure, both groups had reduced mortality, compared with those without primary care exposure.
However, when analyzed by race, in-hospital mortality was not significantly different for Black patients with and without primary care exposure (OR, 1.09), but in-hospital mortality was 21% less in White patients with primary care exposure (OR, 0.79). Interactions between race and primary care exposure related to mortality were not significantly different at any of the follow-up time points of 30, 60, 90, and 180 days.
“These findings suggest that primary care may be exerting a protective effect on postoperative morbidity and mortality,” the researchers wrote in their discussion. “This protective effect could be mediated through several different paths, such as identifying and managing a patient’s comorbidities, medically optimizing patients preoperatively, earlier detection of the primary EGS condition leading to early referral to treatment, and encouraging better lifestyle decisions,” they said.
The findings were limited by several factors including the retrospective design and inability to extract clinical data from a claims database, the researchers noted. Other limitations included potential confounding of unmeasured factors such as the other beneficial health behaviors often associated with seeking primary care.
Patients who avoid primary care may be more likely to delay presentation to the emergency department, which might promote poorer postoperative outcomes, the researchers said. Consequently, surgeons should consider primary care exposure in preoperative assessment, and perform a more comprehensive presurgical assessment as needed, the researchers said.
More studies are needed to examine trends in racial groups, but the results of the current study suggest that primary care provides similar benefits for Black and White individuals, and therefore could help reduce health disparities, they concluded.
Primary care benefits elude many patients
The current study shows a “rather dramatic” association between utilization of primary care within a year before surgery and patient mortality after surgery, wrote Caroline E. Reinke, MD, and David C. Slawson, MD, both of Atrium Health, Charlotte, N.C., in an accompanying editorial. The authors reiterated that possible reasons for the positive effect of primary care on postsurgical mortality included identification and management of comorbidities that could complicate surgery, as well as earlier detection of disease.
However, the editorialists noted that the benefits of primary care exposure depend on patient access to primary care, and on patient adherence to recommendations from their primary care provider. They identified barriers to potential effective interventions with primary care providers including time, money, and transportation.
An unanswered question is “whether the PCP visit itself is the causative factor associated with decreased mortality or if seeing a PCP on an annual basis is a marker of the patient possessing some other ‘magic sauce’ that improves outcomes,” they wrote.
Further, individuals in areas of primary care shortage also are more likely to lack the socioeconomic resources to benefit from primary care, the editorialists said. “Future evaluations of the interaction between PCP visits and social determinants of health may shed light on how to achieve the greatest impact,” they concluded.
Study supports value of consistent primary care
The increasingly aging population across the United States may undergo surgical procedures on an emergent basis and the current study provides data on the benefits of established and effective primary care for these individuals, said Noel Deep, MD, in an interview.
“Having data from this study supports the current position of many physicians and health care organizations and medical professional organizations that older individuals in particular, and adults in general, who have regular routine primary care visits tend to lead healthier lives and have better prognosis and quality of life,” said Dr. Deep, a general internist in private practice in Antigo, Wisc., who was not involved in the study. Dr. Deep also serves as chief medical officer and a staff physician at Aspirus Langlade Hospital in Antigo.
The study findings reinforce what most physicians in primary care, himself included, have been advising adult patients, especially older adults about maintaining regular follow-up visits with their physicians for health screening and management of chronic medical conditions, Dr. Deep said in an interview.
However, barriers to the routine use of primary care to improve postsurgical outcomes include health illiteracy, being overwhelmed by a sudden change in health or emergent surgery, and lack of access to primary care physician, as well as issues such as transportation, financial difficulties, and physical limitations, Dr. Deep added.
“Patients who avoid routine health care visits with primary care may be lacking health insurance or financial resources, have time constraints or family responsibilities, or may be unaware of the benefits of routine health care,” he noted.
As for additional research, “I would like to see studies that can document the impact of having primary care physicians comanage these hospitalized patients in the perioperative period with continued follow-up in the postoperative/convalescent period,” said Dr. Deep.
The study was supported by the National Institute on Aging of the National Institutes of Health. Dr. Roberts disclosed grants from the National Institute on Aging and from NIH during the conduct of the study. The editorial author had no financial conflicts to disclose. Dr. Deep had no financial conflicts to disclose and serves on the Editorial Advisory Board of Internal Medicine News.
Primary care utilization within a year of emergency general surgery was significantly associated with lower mortality up to 180 days later for older adults, based on data from more than 100,000 individuals.
Although previous research has shown the benefits of routine health and preventive care visits for surgery patients, many individuals in the United States live in areas with a shortage of primary care providers, wrote Sanford E. Roberts, MD, of the University of Pennsylvania, Philadelphia, and colleagues. The effect of primary care use on adverse outcomes after emergency general surgery, including mortality, remains unknown, they said.
In a study published in JAMA Surgery the researchers reviewed data from 102,384 Medicare patients aged 66 years and older who underwent emergency general surgery (EGS) between July 1, 2015, and June 30, 2018. Participants were classified into five EGS categories: colorectal, general abdominal, hepatopancreatobiliary, intestinal obstruction, and upper gastrointestinal. The mean age of the participants was 73.8 years; 8.4% were Black, 91.6% were White.
The primary outcome was mortality in hospital and at 30, 60, 90, and 180 days. In the year before hospitalization for EGS, 88,340 patients (86.3%) had visited a primary care physician.
After adjusting for multiple risk factors, the overall risk of in-hospital mortality was 19% lower for patients who had a history of primary care visits than for those without prior-year exposure to primary care (odds ratio, 0.81).
Mortality at 30 days was 27% lower overall in patients with primary care exposure, compared with those without primary care exposure (OR, 0.73). This trend continued at 60 days (OR, 0.75), 90 days (OR, 0.74), and 180 days (OR, 0.75); mortality rates at each time period were similar for Black and White patients with primary care exposure, both groups had reduced mortality, compared with those without primary care exposure.
However, when analyzed by race, in-hospital mortality was not significantly different for Black patients with and without primary care exposure (OR, 1.09), but in-hospital mortality was 21% less in White patients with primary care exposure (OR, 0.79). Interactions between race and primary care exposure related to mortality were not significantly different at any of the follow-up time points of 30, 60, 90, and 180 days.
“These findings suggest that primary care may be exerting a protective effect on postoperative morbidity and mortality,” the researchers wrote in their discussion. “This protective effect could be mediated through several different paths, such as identifying and managing a patient’s comorbidities, medically optimizing patients preoperatively, earlier detection of the primary EGS condition leading to early referral to treatment, and encouraging better lifestyle decisions,” they said.
The findings were limited by several factors including the retrospective design and inability to extract clinical data from a claims database, the researchers noted. Other limitations included potential confounding of unmeasured factors such as the other beneficial health behaviors often associated with seeking primary care.
Patients who avoid primary care may be more likely to delay presentation to the emergency department, which might promote poorer postoperative outcomes, the researchers said. Consequently, surgeons should consider primary care exposure in preoperative assessment, and perform a more comprehensive presurgical assessment as needed, the researchers said.
More studies are needed to examine trends in racial groups, but the results of the current study suggest that primary care provides similar benefits for Black and White individuals, and therefore could help reduce health disparities, they concluded.
Primary care benefits elude many patients
The current study shows a “rather dramatic” association between utilization of primary care within a year before surgery and patient mortality after surgery, wrote Caroline E. Reinke, MD, and David C. Slawson, MD, both of Atrium Health, Charlotte, N.C., in an accompanying editorial. The authors reiterated that possible reasons for the positive effect of primary care on postsurgical mortality included identification and management of comorbidities that could complicate surgery, as well as earlier detection of disease.
However, the editorialists noted that the benefits of primary care exposure depend on patient access to primary care, and on patient adherence to recommendations from their primary care provider. They identified barriers to potential effective interventions with primary care providers including time, money, and transportation.
An unanswered question is “whether the PCP visit itself is the causative factor associated with decreased mortality or if seeing a PCP on an annual basis is a marker of the patient possessing some other ‘magic sauce’ that improves outcomes,” they wrote.
Further, individuals in areas of primary care shortage also are more likely to lack the socioeconomic resources to benefit from primary care, the editorialists said. “Future evaluations of the interaction between PCP visits and social determinants of health may shed light on how to achieve the greatest impact,” they concluded.
Study supports value of consistent primary care
The increasingly aging population across the United States may undergo surgical procedures on an emergent basis and the current study provides data on the benefits of established and effective primary care for these individuals, said Noel Deep, MD, in an interview.
“Having data from this study supports the current position of many physicians and health care organizations and medical professional organizations that older individuals in particular, and adults in general, who have regular routine primary care visits tend to lead healthier lives and have better prognosis and quality of life,” said Dr. Deep, a general internist in private practice in Antigo, Wisc., who was not involved in the study. Dr. Deep also serves as chief medical officer and a staff physician at Aspirus Langlade Hospital in Antigo.
The study findings reinforce what most physicians in primary care, himself included, have been advising adult patients, especially older adults about maintaining regular follow-up visits with their physicians for health screening and management of chronic medical conditions, Dr. Deep said in an interview.
However, barriers to the routine use of primary care to improve postsurgical outcomes include health illiteracy, being overwhelmed by a sudden change in health or emergent surgery, and lack of access to primary care physician, as well as issues such as transportation, financial difficulties, and physical limitations, Dr. Deep added.
“Patients who avoid routine health care visits with primary care may be lacking health insurance or financial resources, have time constraints or family responsibilities, or may be unaware of the benefits of routine health care,” he noted.
As for additional research, “I would like to see studies that can document the impact of having primary care physicians comanage these hospitalized patients in the perioperative period with continued follow-up in the postoperative/convalescent period,” said Dr. Deep.
The study was supported by the National Institute on Aging of the National Institutes of Health. Dr. Roberts disclosed grants from the National Institute on Aging and from NIH during the conduct of the study. The editorial author had no financial conflicts to disclose. Dr. Deep had no financial conflicts to disclose and serves on the Editorial Advisory Board of Internal Medicine News.
FROM JAMA SURGERY