Preoperative primary care utilization may reduce mortality after emergency general surgery: JAMA

A new study by Sanford Roberts and team found that primary care use had no effect on in-hospital mortality for Black patients in a research of both Black and White Medicare participants, but was related with lower mortality for White patients. The findings of this study were published in the Journal of American Medical Association.

In the United States, 65 million people reside in primary care shortage regions, with approximately one-third of Medicare patients requiring a primary care health care provider. Periodic health checkups and preventive care visits have been shown to benefit surgical patients; however, the influence of primary care health care worker shortages on unfavorable surgical outcomes is uncertain. As a result, this study was conducted to see if preoperative primary care utilization is related to postoperative mortality after an emergency general surgery (EGS) operation in Black and White older persons.

This was a retrospective cohort research conducted at emergency departments in US hospitals. Participants were Medicare patients aged 66 and up who were hospitalized to the emergency department for an EGS disease between July 1, 2015, and June 30, 2018, and received surgery on hospital days 0, 1, or 2. The study was completed in December 2022. Based on their primary diagnostic codes, patients were assigned to one of five EGS disease categories: colorectal, general abdominal, intestinal obstruction, hepatopancreatobiliary, or upper gastrointestinal.

The key findings of this study were:

The research had 102 384 patients in all.

There were 8559 Black people (8.4%) and 93 825 White people (91.6%) among them.

In the year preceding their initial hospitalization, 88 340 individuals (86.3%) had seen a primary care physician.

After risk adjustment, patients who had received primary care had a 19% reduced risk of in-hospital mortality than patients who had not received primary care.

Patients who received primary care had a 27% decreased risk of death after 30 days. At 60 days, 90 days, and 180 days, this remained very consistent.

At every time interval, none of the interactions between race and primary care physician mortality risk were statistically different.

Reference:

Roberts, S. E., Rosen, C. B., Keele, L. J., Kaufman, E. J., Wirtalla, C. J., Finn, C. B., Moneme, A. N., Bewtra, M., & Kelz, R. R. (2023). Association of Established Primary Care Use With Postoperative Mortality Following Emergency General Surgery Procedures. In JAMA Surgery. American Medical Association (AMA). https://doi.org/10.1001/jamasurg.2023.2742