Perioperative medicine & outcomes
Perioperative Primary Care Utilization and Postoperative Readmission, Emergency Department Use, and Mortality in Older Surgical Patients
Authors' conclusion
In those patients who do utilize primary care, compared with propensity-matched patients who do not, our study suggests primary care use is associated with modestly lower readmission rates.
Study context
- Population
- Medicare beneficiaries aged ≥65 undergoing major inpatient diagnostic or therapeutic procedures, 2017–2018
- Participants
- 3,552,906 beneficiaries
- Exposure
- Postdischarge primary care visit within 14 days vs no visit; Annual Wellness Visit in prior year vs none
- Postdischarge visitn = 336,837
- Annual Wellness Visitn = 104,571
- Outcome
- Unplanned readmission
- Follow-up
- 30 days
Methodological detailspropensity-matched, Cox proportional hazards regression
- Propensity-matched
- Cox proportional hazards regression
Main finding
As reported in the abstract
30-day unplanned readmission
Hazard ratio (95% CI)
Postdischarge visit vs No postdischarge visit5% lower risk
0.95(0.93–0.97)
Annual Wellness Visit vs No Annual Wellness Visit9% lower risk; secondary exposure
0.91(0.88–0.95)
- Readmitted, overall cohort
- 9.5% (n = 336,401)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (95% CI) | |
|---|---|---|
| ED visits · 30 daysPostdischarge visit vs No postdischarge visit · 43% higher risk | 1.43 (1.40–1.46) | |
| ED visits · 30 daysAnnual Wellness Visit vs No Annual Wellness Visit · 45% higher risk | 1.45 (1.40–1.49) | |
| Mortality · 30 daysPostdischarge visit vs No postdischarge visit | 0.98 (0.90–1.06) | |
| Mortality · 30 daysAnnual Wellness Visit vs No Annual Wellness Visit · 18% lower risk | 0.82 (0.75–0.89) | |
| 0.512Hazard ratio (log scale) |
- ED visits — ED visits, overall cohort
- 9% (n = 319,054)
- Mortality — Died, overall cohort
- 0.6% (n = 22,103)
Original publication
Perioperative Primary Care Utilization and Postoperative Readmission, Emergency Department Use, and Mortality in Older Surgical Patients. Anesth Analg. Published 7 June 2024. doi:10.
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